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THE GROWTH OF MEDICINE 
FROM THE EARLIEST TIMES TO ABOUT 1800 



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Published on the Foundation 
Established in Memory of 

WILLIAM CHAUNCEY WILLIAMS 
OF THE Class of 1822, Yale Medical School 

AND OF 

WILLIAM COOK WILLIAMS 
OF THE Class of 1850, Yale Medical School 



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THE GROWTH OF MEDICINE ^ 



FROM THE EARLIEST TIMES 
TO ABOUT 1800 



By 
ALBERT H. BUCK, B.A., M.D. 

Formerlv Clinical Professor of Diseases of the Ear, Columbia 

University, New York — Consulting Aural Surgeon, 

New York Eye and Ear Infirmary; etc. 




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NEW HAVEN: YALE UNIVERSITY PRESS 

LONDON: HUMPHREY MILFORD 

OXFORD UNIVERSITY PRESS 

MDCCCCXVII 



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Copyright, 1917 
By Yale University Press 



First published, February, 1917 



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THE WILLIAMS MEMORIAL PUBLICATION 

FUND 

The present volume is the first work published by the 
Yale University Press on the Williams Memorial Publica- 
tion Fund. This Foundation was established June 15, 1916, 
by a gift made to Yale University by Dr. George C. F. 
Williams, of Hartford, a member of the Class of 1878, Yale 
School of Medicine, where three generations of his family 
studied — his father, William Cook Williams, in the Class 
of 1850, and his grandfather, William Chauncey Williams, 
in the Class of 1822. 



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PREFACE 

Very few persons will challenge the truth of the state- 
ment that in the United States and Canada there are not 
many physicians who possess even a slight knowledge 
concerning the manner in which the science of medicine 
has attained its present power as an agency for good, or 
concerning the men who played the chief parts in bringing 
about this great result. Up to the present time no blame 
may justly be attached to any individuals or to any educa- 
tional institutions for this prevailing lack of knowledge, 
and for two very good reasons, viz. : first, in a newly settled 
country, in which the population grows by leaps and 
bounds through the influx of foreign immigrants, the train- 
ing of young men for the degree of M.D. must necessarily 
be almost entirely of a practical character, and conse- 
quently the teaching of such a subject as the history of 
medicine would be quite out of place; and, second, the 
treatises on this subject which are purchasable by English- 
speaking physicians are of rather too scientific a character 
to appeal either to the undergraduate or to the busy 
practitioner. The first of the reasons named, it may now 
safely be assumed, is rapidly losing its validity, if indeed 
it has not already ceased entirely to afford a legitimate 
excuse for neglecting the study of this branch of medical 
science. On the other hand, the second reason mentioned 
is still in force, — so far at least as the present writer 
knows, — and, if such be the case, it certainly cannot fail 
to act as a deterrent influence of great potency. Here, 
then, is my apology for attempting to prepare an account 
of the history of medicine which shall present the essential 
facts truthfully and with a sufficient degree of attractive- 
ness to win the continuing interest of the reader; which 
shall place before him, and especially before those who 
are just at the threshold of their professional career, 
word pictures of those physicians of past ages whose lives 



X PREFACE 

may safely be taken as models worthy to be copied; and 
which shall describe, so far as I am able to do this, the 
methods which they employed to advance the science of 
medicine, to gain genuine professional success, and to 
merit the enduring esteem of later generations of physi- 
cians. If my efforts prove successful in producing this 
kind of history it is fair to expect that, in a comparatively 
short time, those physicians whose interest may have been 
aroused by the perusal of this less complete and more 
popular work, will demand something of a more exhaustive 
character — a book, for example, like the admirable history 
which Max Neuburger, of Vienna, is now publishing, and 
of which two volumes have already issued from the press 
(the first in 1906 and the second in 1911)/ It is to this 
work and the excellent history written by the late Dr. 
Haeser, of Breslau, that I am chiefly indebted for the 
information supplied in these pages ; and I therefore desire 
to make special mention here of this indebtedness. The 
other sources from which I have been an occasional 
borrower are all mentioned in the ''List of Authorities 
Consulted." Footnotes and cross-references in the text 
interfere greatly with one's pleasure in reading a book, 
and I have therefore not hesitated to introduce them 
sparingly. 

It gives me a special pleasure to call attention here to 
the far-sighted generosity displayed by the founder of 
The Williams Memorial Fund in making it practicable 
henceforth for the Yale University Press to accept for 
publication medical treatises which deal with the historical 
and scientific questions of this branch of knowledge, but 
which for sound business reasons cannot be published on 
a merely commercial basis. 

And I have the further pleasure of expressing my real 
appreciation of the skill with which the University Press 
has solved the problems of a suitable size and style of type 

1 A third volume is in course of preparation, but the probable date of its 
publication has not been announced. An English translation of the first 
volume (by Ernest Playfair) was published by Hodder and Stoughton, of 
London, in 1910. 



PREFACE ' xi 

for this volume, and of the sound advice which it has given 
with regard to the extent to which the effectiveness of the 
book may be increased by the introduction of pictorial 
illustrations. 

To my friend, Lawrence F. Abbott, of New York, I am 
deeply indebted for the valuable assistance which he has 
rendered me throughout the entire progress of this work. 
Indeed, without this assistance, I doubt whether I should 
have had the courage to remain at my post to the very end. 

Albert H. Buck. 
Cornwall, N. Y., December 29, 1916. 



CONTENTS 
PART I. ANCIENT MEDICINE 

PAGE 

Preface ix 

Chapter I. Development of the Science and Art of 

Medicine ........ 3 

Chapter II. Oriental Medicine ..... 13 

Chapter III. Oriental Medicine (continued) . . .25 

Chapter IV. Greek Medicine at the Dawn of History . 46 

Chapter V. The Significance of the Serpent in the 
Statues and Votive Offerings Exposed to View in 
the Aesculapian Temples ..... 62 

Chapter VI. The Beginnings of a Rational System of 

Medicine in Greece ...... 67 

Chapter VII. Hippocrates the Great .... 81 

Chapter VIII. Brief Extracts from Some of the Hip- 

pocratic Writings ...... 89 

Chapter IX, The State of Greek Medicine after the 
Events of the Peloponnesian War; the Founding of 
Alexandria in Egypt, at the Mouth of the Nile; and 
the Development of Different Sects in Medicine . 96 

Chapter X. Erasistratus and Herophilus, the Two Great 
Leaders in Medicine at Alexandria; the Founding 
of New Sects 104 

Chapter XI. Asclepiades, the Introducer of Greek Medi- 
cine into Rome ....... 116 

Chapter XII. The State of Medicine at Rome after the 
Death of Asclepiades; the Founding of the School 
of the Methodists 129 

Chapter XIII. The Further History of Methodism at 
Rome, and the Development of Two New Sects, viz., 
the Pneumatists and the Eclectics. — A General Sur- 
vey of the Subject of Sects in Medicine . . . 138 



xiv CONTENTS 



PAGE 



Chapter XIV. Well-known Medical Authors of the Early 

Centuries of the Christian Era .... 151 

Chapter XV. Claudius Galen . . . . .160 

Chapter XVI. The Influence of Christianity upon the 

Evolution of Medicine 179 



PART II. MEDIAEVAL MEDICINE 

Chapter XVII. The Condition of Medicine at Byzantium 

during the Early Part of the Middle Ages . . 191 

Chapter XVIII. Beginning of the Arab Renaissance under 

the Caliphs of Bagdad . . . . . .203 

Chapter XIX. Further Advance of the Arab Renaissance 
during the Ninth and Succeeding Centuries of the 
Christiiin Era . . . . . . .212 

Chapter XX. Hospitals and Monasteries in the Middle 

Ages 235 

Chapter XXI. Medical Instruction at Salerno, Italy, in 

the Middle Ages 243 

Chapter XXII. Early Evidences of the Influence of the 
Renaissance upon the Progress of Medicine in West- 
ern Europe ....... 259 

Chapter XXIII. Further Progress of Medicine and Sur- 
gery in Western Europe during the Thirteenth, 
Fourteenth and a Part of the Fifteenth Centuries . 269 

Chapter XXIV. During the Latter Half of the Middle 
Ages Surgery Assumes the Most Prominent Place 
in the Advance of Medical Science . . . . 292 

Chapter XXV. Brief History of the Allied Sciences — 

Pharmacy, Chemistry and Balneotherapeutics . . 315 

PART III. MEDICINE DURING THE RENAISSANCE 

Chapter XXVI. Important Events that Preceded the 
Renaissance — Early Attempts to Dissect the Human 
Body 327 



CONTENTS XV 

PAGE 

Chapter XXVII. The Founders of Human Anatomy and 

Physiology ....... 340 

Chapter XXVIII. Further Details Concerning the Ad- 
vance in Our Knowledge of Anatomy. — Dissecting 
Made a Part of the Regular Training of a Medical 
Student. — latrochemists and latrophysicists. — The 
Employment of Latin in Lecturing and "Writing on 
Medical Topics 355 

Chapter XXIX. The Contributions Made by Different 
Men during the Renaissance, and More particularly 
by William Harvey of England, to Our Knowledge 
of the Circulation of the Blood, Lymph and Chyle . 371 

Chapter XXX. Advances Made in Internal Medicine and 
in the Collateral Branches of Botany, Pharmacology, 
Chemistry and Pathological Anatomy . . . 387 

Chapter XXXI. Chemistry and Experimental Pharma- 
cology ........ 398 

Chapter XXXII. Some of the Leaders in Medicine in 
Italy, France and England during the Sixteenth and 
Seventeenth Centuries ...... 411 

Chapter XXXIII. The Three Leading Physicians of Ger- 
many during the Latter Half of the Seventeenth Cen- 
tury: Franz de le Boe Sylvius, Friedrich Hoffmann 
and Georg Ernst Stahl 426 

Chapter XXXIV. Hermann Boerhaave of Leyden, Hol- 
land, one of the Most Distinguished Physicians of 
the Seventeenth Century ..... 438 

Chapter XXXV. General Remarks on the Development of 
Surgery in Europe during the Fifteenth and Six- 
teenth Centuries . . . . . . 446 

Chapter XXXVI. Surgery in Germany and Switzerland 

during the Fifteenth and Sixteenth Centuries . . 454 

Chapter XXXVII. The Development of Surgery in Italy 

during the Renaissance ..... 472 

Chapter XXXVIII. The Development of Surgery in 

Spain and Portugal during the Renaissance . . 484 



xvi CONTENTS 



PAGE 



Chapter XXXIX. The Development of Surgery in France 

during the Renaissance. — Pierre Franco . . . 490 

Chapter XL. The Development of Surgery in France 

(continued). — Ambroise Pare .... 499 

Chapter XLI. Surgery in Great Britain during the Six- 
teenth and Seventeenth Centuries .... 516 

Chapter XLII. Reforms Instituted by the Italian Surgeon 
Magati in the Treatment of Wounds. — Final Ending 
of the Feud between the Surgeons and the Physicians 
of Paris. — Revival of Interest in the Science of 
Obstetrics 529 

Chapter XLIII. The First Appearance of Syphilis in 
Europe as an Epidemic Disease. — Medical Journal- 
ism. — The Beginnings of a Modern Pharmaco- 
poeia. — Itinerant Lithotomists .... 542 

List of the More Important Authorities Consulted . . 557 

General Index ........ 563 



LIST OF ILLUSTRATIONS 

Fig. 1. View of the Temple of Aesculapius on the Island 

of Cos ..... facing page 52 

Fig. 2. Bird's-eye View of the Temple of Aesculapius 
and Associated Buildings on the Island of Cos 

facing page 54 

Fig. 3. Ground Plan of the Asclepieion on the Island 

of Cos ..... facing page 55 

Fig. 4. Ancient Statue of the God Aesculapius in the 

Berlin Museum .... facing page 62 

Fig, 5. Head of the Marble Statue of the God Aesculapius 

in the Naples Museum . . facing page 62 

Fig. 6. Bas-relief of Aesculapius, Accompanied by- 
Women and Children, in the Presence of an 
Enormous Serpent . . . facing page 68 

Fig. 7. Female Bust Showing Cancer of One Breast 

facing page 68 

Fig. 8, Paralysis of the Left Facial Nerve . facing page 70 

Fig. 9. The Oldest Known Pictorial Representation of a 
Formal Dissection of the Human Body 

facing page 280 

Fig. 10. The Manner of Giving Public Instruction in 

Medicine during the Middle Ages . . .281 

Fig. 11. Henri de Monde ville . . . facing page 288 

Fig. 12. One of the Wards in the Hotel-Dieu of Paris 

facing page 304 

Fig. 13. The Physician, the Surgeon and the Pharmacist 

facing page 306 
Fig. 14. Andreas Vesalius . . . . facing page 344 

Fig. 15. William Harvey .... facing page 380 
Fig. 16. "The Lovesick Maiden" . . . facing page 412 

Fig. 17. Thomas Sydenham . . . facing page 418 



xvin LIST OF ILLUSTRATIONS 

Fig. 18. Consultation by Three Physicians upon a Case 

of Wound in the Chest . . . .457 

Fig, 19. Barber Surgeon (Wundarzt) Extracting an 
Arrow from a Wounded Soldier's Chest while 
the Battle is Still in Progress . . . 461, 

Fig. 20. Amputation of the Leg 463 

Fig. 21. The Manner in Which the So-called Tagliacotian 
Operation for Repairing a Defective Nose 
Should be Carried Out . . . .480 

Fig. 22. Pierre Franco's Forceps for Crushing Calculi in 

the Urinary Bladder ..... 497 

Figs. 23-24. Forceps Devised in 1552 by Ambroise Pare for 
Drawing Out the Cut Ends of Arteries after 
the Amputation of a Limb, and Holding Them 
while the Ligature is Being Applied . . 512 

Fig. 25. Ambroise Pare, the Famous French Surgeon of 

the Sixteenth Century , . facing page 514 

Fig. 26. Frere Jacques de Beaulieu . . facing page 550 

Fig. 27. Jean Baseilhac, commonly Known in France as 

Frere Come .... facing page 552 

Fig. 28. Concealed Lithotome Invented by Frere Come in 

1748 553 



PART I 
ANCIENT MEDICINE 



CHAPTER 1 

DEVELOPMENT OF THE SCIENCE AND ART 
OF MEDICINE 

Friedlaender says that *4n the temple of history, now 
hoary with age, medicine also possesses its own chapel, 
not an accidental addition to the edifice but a large and 
important part of the noble building." In this chapel is 
preserved the record of the efforts made by man, through 
the ages, to maintain his body in good condition, to restore 
it to health when it has become affected by disease or 
damaged by violence, and to ward off the various maladies 
to which it is liable. It is a record, therefore, in which 
every practitioner of medicine should take a deep interest. 
Rokitansky, the famous pathologist of Vienna, expressed 
the same idea very tersely when he said: ** Those about 
to study medicine and the younger physicians should light 
their torches at the fires of the ancients." Members of the 
medical profession, however, are not the only persons in 
the community who take an interest in the origin and 
growth of the science of medicine and the art of healing 
the diseased or damaged body ; the educated layman is but 
little less interested than the physician, being ever ready 
to learn all he can about the progress of a branch of knowl- 
edge which so profoundly affects his welfare. But hitherto 
the only sources of information available for those who are 
not familiar with French or German have been treatises of 
so technical a character that even physicians have shown 
relatively little disposition to read them. 

The science of medicine developed slowly from very 
humble beginnings, and for this earliest period the historian 
has no records of any kind which may be utilized for his 



4 GROWTH OF MEDICINE 

guidance. It is reasonably certain, furthermore, that this 
prehistoric period lasted for a very long time, probably 
several thousand years; and when, finally, some light on 
the subject appeared, it was found to emanate from several 
widely separated regions — e.g., from India, Mesopotamia, 
Egypt and Greece. Then, after the lapse of additional 
hundreds or even thousands of years, there was inaugurated 
the practice of making written records of all important 
events, and, among others, of the different diseases which 
affect mankind, of the means employed for curing them or 
for relieving the effects which they produce, and of the men 
who distinguished themselves in the practice of this art. 
While the ''science of the spade" and that of deciphering 
the writing of the papyri, monuments and tablets thus 
brought to light, have already during the last half century 
greatly altered our ideas with regard to ancient medicine, 
there are good reasons for believing that much additional 
information upon this subject may be looked for in the not 
distant future. It is plain, therefore, that a history of the 
primitive period of medicine, if written to-day, may have 
to be modified to-morrow in some important respects. On 
the other hand, the facts relating to the later periods are 
now so well established that a fair-minded writer should 
experience no serious difficulty in judging correctly with 
regard to their value and with regard to the claims of the 
different men to be honored for the part which each has 
played in bringing the science and art of medicine to their 
present high state of completeness and efficiency. 

The subdivision of the history of medicine into separate 
periods is certainly desirable, provided it be found prac- 
ticable to assign reasonably well-defined limits to the 
periods chosen. But, when the attempt is made to establish 
such subdivisions, one soon discovers that the boundaries 
pass so gradually the one into the other at certain points, 
or else overlap so conspicuously at other points, that one 
hesitates to adopt any fixed plan of classification. Of 
the four schemes which I have examined — viz., those of 
Daremberg, of Aschoff, of Neuburger, and of Pagel — that 
of Neuburger seems to me to be the best. That which has 



BEGINNINGS OF MEDICINE 5 

been adopted, however, in the preparation of the present 
outline sketch combines some of the features of both the 
Pagel and the Neuburger schemes. 

Periods in the History of Medicine. — There are nine 
more or less distinctly defined periods in the history of 
medicine, to wit: — 

First Epoch : Primitive medicine. — This period extends 
through prehistoric ages to a date which differs for 
different parts of the world. The duration of this period, 
in any case, is to be reckoned by thousands of years. 

Second Epoch: The medicine of the East — that is, of 
the cultivated oriental races of whose history we possess 
only a very fragmentary knowledge. 

Third Epoch: The medicine of the classical period of 
antiquity — the pre-Hippocratic period of Greek medicine. 

Fourth Epoch : The medicine of the Hippocratic writ- 
ings — the most flourishing period of Greek medicine. 

Fifth Epoch : The medicine of the period during which 
the centre of greatest intellectual activity was located at 
Alexandria, Egypt. 

Sixth Epoch : The medicine of Galen — an author whose 
teachings exerted a preponderating influence upon the 
thought and practice of physicians in every part of the 
civilized world up to the seventeenth century of the 
Christian era. This period is also characterized by the 
gradual diminution of the influence of Greek medicine. 

Seventh Epoch: The medicine of the Middle Ages — a 
period which includes a large part of the preceding epoch. 
Its most characteristic feature is the important part played 
by the Arabs in moulding the teachings and practice of the 
medical men of that time (ninth to fifteenth century). 

Eighth Epoch (fifteenth and sixteenth centuries) : The 
medicine of the Renaissance period — characterized chiefly 
by the adoption of the only effective method of studying 
the anatomy of man — the actual dissection of human bodies. 

Ninth Epoch (from the beginning of the seventeenth 
century to the present time) : Modern medicine. — This 
epoch may with advantage be divided into two periods — 
the first extending to about the year 1775, soon after which 



6 GROWTH OF MEDICINE 

time Jenner began Ms important work on the subject of 
vaccination; and the second to the present time. No 
attempt will be made in the following account to cover this 
second period. 

The Beginnings of Medicine. — In the early period of 
man's existence upon this earth he must have possessed 
an exceedingly small stock of knowledge with regard to 
the maintenance of his body in health and with regard to 
the means which he should adopt in order to restore it to 
a normal condition after it had been injured by violence 
or impaired in its working machinery by disease. With the 
progress of time, utilizing his powers of observation and 
his reasoning faculty, he slowly made additions to his stock 
of facts of this nature. Thus, for example, he gradually 
learned that cold, under certain circumstances, is competent 
to produce pain in the chest, shortness of breath, active 
secretion of mucus, etc., and his instinct led him, when he 
became affected in this manner, to crave the local appli- 
cation of heat as a means of affording relief from these 
distressing symptoms. Again, when he used certain plants 
as food he could scarcely fail to note the facts that some 
of them produced a refreshing or cooling effect, that others 
induced a sensation of warmth, and finally that others still, 
by reason of their poisonous properties, did actual harm. 
Sooner or later, such phenomena as nausea, vomiting and 
diarrhoea would also be attributed by him to their true 
causes. In due course of time his friends and neighbors, 
having made similar observations and having tried various 
remedial procedures for the relief of their bodily ills, would 
come together and compare with him their several expe- 
riences; and so eventually the fact would be brought out 
that the particular method adopted by one of their number 
for the relief of certain symptoms had proved more 
effective than any of the others. Thus gradually this 
isolated community or tribe of men must have learned how 
to treat, more or less successfully, the simpler ills to which 
they were liable. 

Lucien Le Clerc quotes from the Arab historian Ebn Abi 
Ossaibiah the following account of the manner in which 



BEGINNINGS OF MEDICINE 7 

bloodletting probably first came to be adopted as a remedial 
measure : — 

Let us suppose that in the earliest period of man's history some- 
body experienced the need of the medical art. He may, for 
example, have felt a general sense of heaviness in his body 
(plethora), associated perhaps with redness of the eyes, and he 
probably did not know what he should do in order to obtain relief 
from these sensations. Then, when his trouble was at its worst, 
his nose began to bleed, and the bleeding continued until he 
experienced decided relief from his discomfort. In this way he 
learned an important fact, and cherished it in his memory. 

On a later occasion he experienced once more the same sense 
of heaviness, and he lost no time in scratching the interior of his 
nose in order to provoke a return of the bleeding. The nose- 
bleed thus excited again gave him entire relief from the unpleasant 
sensations, and upon the first convenient occasion he told his 
children and all his relatives about the successful results obtained 
from this curative procedure. Little by little this simple act, 
which was a first step in the healing art, developed into the 
intelligently and skilfully performed operation of venesection. 

Primitive man also increased bis stock of knowledge in 
the healing art by reading attentively the book of nature, — 
i.e., by observing how animals, when ill, eat the leaves or 
stems of certain plants and thus obtain relief from their 
disorders. The virtues of a species of origanum, as an 
antidote for poisoning from the bite of a snake, were 
revealed, it is asserted, by the observation that turtles, 
when bitten by one of these reptiles, immediately seek for 
the plant in question and, after feeding upon it, experience 
no perceptible ill effects from the poisonous bite. The 
natives of India ascribe the discovery of the remarkable 
virtues of snakeroot (the bitter root of the ophiorrhiza 
Mungos) as an antidote for poisoning by the bite of a snake, 
to the ichneumon, a small animal of the rat species. The 
instinctive desire to escape pain taught man, as it does the 
lower animals, to keep a fractured limb at rest, thus giving 
the separated ends of the bone an opportunity to reunite; 
after which the limb eventually becomes as strong as it 
ever was. Simple as this mode of acquiring useful medical 



8 GROWTH OF MEDICINE 

knowledge may appear to us moderns, there are good 
reasons for believing that hundreds of years must have 
elapsed before the accumulated stock of such experiences 
became really considerable. On the other hand, it is 
reasonable to suppose that this growth in medical knowl- 
edge took place more rapidly in certain tribes or races than 
in others, and that when, under the action of wars, the 
inferior men became tributary to those of greater intel- 
lectual powers, they acquired, through contact with their 
conquerors, additional knowledge at a much more rapid 
rate. One great hindrance, however, stood in the way of 
such progress. I refer to the deeply rooted belief, enter- 
tained by man in this primitive period of his existence, in 
the agency of malevolent spirits (demons) in the production 
of disease, — a belief which continued to exist for many 
thousands of years. Out of such a belief developed the 
necessity of discovering some practical method of appeasing 
the evil spirits and of thus obtaining the desired cure of 
the ills of the body. Usually some member of the tribe 
who had displayed special skill in the treatment of disease, 
and who at the same time was liberally endowed with the 
qualities which characterize the charlatan, was chosen to 
be the priest or ''medicine man." It was his duty to 
employ measures suitable for expelling the demon from 
the patient's body and for restoring the latter to health. 
Possessing great influence, as these superstitious people 
believed he did, with the unseen gods, such a physician- 
priest must have discouraged all efforts to increase the 
stock of genuine medical knowledge; for such an increase 
would necessarily mean a diminution of his own power 
and influence. 

In what must still be termed the age of primitive medi- 
cine, but undoubtedly at an advanced stage of that epoch, 
there were performed surgical operations which imply a 
remarkable advance in the invention of cutting instruments 
and in the knowledge of the location and nature of certain 
comparatively rare diseases, and at the same time great 
courage and wonderful enterprise on the part of those 
early physicians. As evidence of the correctness of these 



BEGINNINGS OF MEDICINE 9 

statements the fact may be mentioned that trepanned skulls 
belonging to the neolithic period have been dug up in 
various parts of the world — in most of the countries of 
Europe, in Algiers, in the Canary Islands, and in both 
North and South America. From a careful study of these 
skulls it has been learned that the individuals upon whom 
such severe surgical work had been done — sometimes as 
often as three separate times — recovered from the opera- 
tion. The instruments used were made of sharpened flint 
(saws or chisels). Pain in the head, spasms or convulsions, 
and mental disorders are suggested by Neuburger as the 
indications which probably led to the performance of the 
trepanning. This author also makes the further statement 
that the ancient Egyptians employed knives made of flint 
for opening the dead bodies which they were about to 
embalm and for the operation of circumcision. Recent 
excavations have thrown additional light upon the state 
of medical knowledge during this neolithic age. Thus, 
there have been found specimens of anchylosed joints, of 
fractured bones, of flint arrow heads lodged in different 
parts of the skeleton, of rhachitis, of caries and necrosis 
of bone, etc. The following quotation is taken from the 
printed report of a lecture recently delivered in London 
by Dr. F. M. Sandwith, Consulting Surgeon to the Khedive 
of Egypt. Speaking of certain excavations made in the 
Nubian Desert and of the oldest surgical implements yet 
discovered, he says : — 

In one place a graveyard was found, and here were remains of 
bodies with fractured limbs that had been set with bark splints. 
One was a right thigh bone that had been broken, and was still 
held in position by a workmanlike splint and bandages. All the 
knots were true reef-knots, and the wrappings showed how the 
strips of palm-fibre cloth were set just as a good surgeon would 
set them in these days so as to use the full strength of the fabric. 

Among the most ancient remedies may be mentioned 
talismans, amulets and medicine stones, which were fur- 
nished — presumably at a price — by the physician-priests, 
and which were believed to afford the wearers protection 



10 GROWTH OF MEDICINE 

against evil spirits (the **evil eye," for example). Various 
objects were used for this purpose, and among them the 
following deserve to be mentioned : disks of bone removed 
with the aid of a trephine from the skull of a dead human 
body and worn with a string around the neck ; the teeth of 
different animals; bones of the weasel; cats' claws; the 
lower jaw of a squirrel; the trachea of some bird; one of 
the vertebrae of an adder, etc. And where these measures 
failed, the priests resorted to incantations, religious dances, 
and the beating of drums or the rattling of dried gourds 
filled with pebbles. Primitive races of men inhabiting the 
most widely separated parts of the earth appear to have 
adopted means almost identical with those just described 
for driving away evil spirits. The holding of these super- 
stitious beliefs is one of the most extraordinary character- 
istics of the human race. It played an important part 
throughout the classical period of Greek and Eoman 
civilization, and also during the Middle Ages. Christianity 
undoubtedly was a most potent agency in hastening the 
eradication of the feeling, but even this great power has 
not yet sufficed entirely to do away with superstition; for 
traces of this weakness may still easily be detected in some 
of the men and women with whom we daily come in contact. 



CHAPTEK II 
ORIENTAL MEDICINE 

The researches of the scholar working in combination 
with the engineer have unearthed — ^more particularly in 
Mesopotamia, in Egypt and in Greece — evidences of an 
ancient medical science far advanced beyond that briefly 
described in the preceding chapter. These evidences relate 
to nations that flourished as far back as four thousand 
years B. C. While they are very fragmentary and cover 
historical events which are often separated from one 
another by long periods of time, these data nevertheless 
suffice to give one a fairly good idea of the then prevailing 
state of medical knowledge. Both Pagel and Neuburger 
adopt the plan of discussing these different nationalities 
separately, and I shall follow their example. 

Medicine in Mesopotamia. — As appears from the most 
recent investigations the Sumerians were the first occu- 
pants of the region lying between the Euphrates and the 
Tigris rivers. It was from them that their Semitic con- 
querors, the Babylonians and the Assyrians, received a 
civilization which, already about 4000 B. C, had reached 
a wonderful degree of development. The canalization of 
the low-lying lands of that 'region, the organization of a 
religious and civil government of a most efficient type, the 
invention first of picture-writing and then of the cuneiform 
characters, the cultivation of the arts and natural sciences 
and especially of astronomy and mathematics to a high 
degree of perfection, — these are among the things which 
were accomplished by this very clever race of men. In 
addition, however, to these useful activities the Babylo- 
nians developed and cultivated diligently the science of 
astrology — that is, the science of predicting human events 



12 GROWTH OF MEDICINE 

(such as the death of the king, the occurrence of the plague 
or of war, etc.) from various telluric and cosmic phe- 
nomena — an eclipse of the sun, peculiarities of the 
weather, the condition of vegetation, etc. The deeply- 
rooted love of the human race for the supernatural — a 
characteristic to which I have already briefly referred — 
facilitated the development of this harmful practice, and 
kept it alive through many succeeding centuries. Walter 
Scott, in his romance entitled Quentin Durward, gives an 
admirable portrait of a typical astrologer whom Louis XI. 
of France maintained at his court during a part of the 
seventeenth century. 

While in other parts of the Orient the science of medi- 
cine, as already stated at the beginning of this chapter, 
made a noteworthy advance beyond the conditions observed 
among the primitive races, in Mesopotamia this science, 
which was far more important to the welfare of its inhabi- 
tants than all the other branches of knowledge combined, 
received very little attention and consequently made only 
insignificant advances. The British Museum has in its 
possession several thousand tablets which were dug up 
from the ruins of Nineveh and which represent a part of 
the library of the Assyrian King, Assurbanipal (668-626 
B. C). Translations of the text of only a very few of 
these tablets have thus far been published, and from these, 
which embody the greater part of our knowledge of 
Assyrian medicine, it appears that, for the present at least, 
the estimate recorded above must stand. A few new facts, 
however, have been brought to light, and they appear to 
be of sufficient importance to merit brief consideration here. 

In the first place, Herodotus, who visited Babylon about 
300 B. C, has this to say in relation to the state of medicine 
in that city: — 

The following custom seems to me the wisest of their institutions 
next to the one lately praised. They have no physicians, but, when 
a man is ill, they lay him in the public square, and the passers-by 
come up to him, and if they have ever had his disease themselves 
or have known any one who has suffered from it, they give him 
advice, recommending him to do whatever they found good in their 



ORIENTAL MEDICINE 13 

own case, or in the case known to them; and no one is allowed to 
pass the sick man in silence without asking him what his ailment is.^ 

The Babylonians held some rather strange beliefs 
regarding the construction of the human body and the 
manner in which its functions are performed. The living 
being, as they maintained, is composed of soul and body. 
The intellect has its seat in the heart, the liver serving as 
the central organ for the blood, which they considered to 
be the true life principle. They divided this fluid into two 
kinds — blood of the daytime (bright arterial) and that of 
the night (dark venous). Although the blood was held 
by them to be the basis of life, they evidently attached a 
certain value to respiration, for one of their prayers begins 
with these words : * * God, my creator, lead me by the hand ; 
guide the breath of my mouth. ' * Disease was always looked 
upon as something (usually personified as a demon) that 
entered the body from without and that consequently had 
to be expelled. There were special demons for the different 
diseases. Thus, Asakku brought fever to the head, Namtar 
threatened life with the plague, and Utukku attacked the 
throat, Alu the breast, Gallu the hand, Rabisu the skin, and 
so on. The most dreaded demons were the spirits of 
the dead. Special amulets were employed as protective 
remedies. Prayer formulae were also used. Here is one 
among several that I find mentioned in Neuburger's 
treatise : — 

Wicked Consumption, villainous Consumption, Consumption 
which never leaves a man, Consumption which cannot be driven 
away, Consumption which cannot be induced to leave. Bad 
Consumption, in the name of Heaven be placated, in the name of 
Earth I conjure thee ! 

The genuine remedial agents employed in Babylonia 
were of a most varied nature: a mixture of honey and 
syrup of dates; medicinal herbs of different kinds for 
internal administration; bloodletting; the use of cups for 
drawing blood to the surface of the body ; warm baths and 

1 Book I,, section 197, of Eawlinson's translation. 



14 GROWTH OF MEDICINE 

cold shower baths; rubbing oil over the body; medicated 
clysters; the use of various salves; the use of secret 
remedies which were composed of various ingredients and 
which bore such names as *'the Sun God's remedy," **the 
dog's tongue," "the skin of the yellow snake," ''the 
medicine brought from the mountain of the human race," 
etc. 

Some of the predictions made by the Babylonian astrolo- 
gers are of sufficient interest to be placed on record. Here 
are a few examples : — 

If the west wind is blowing when the new moon is first seen, 
there is hkely to be an unusual amount of illness during that 
month. 

If Venus approaches the constellation of Cancer, there will be 
respect for law and prosperity in the land; those who are ill will 
recover, and pregnant women will have easy confinements. 

If Mercury makes its appearance on the fifteenth day of the 
month, there will be corpses in the land. And again, if the con- 
stellation of Cancer is obscured, a destructive demon will take 
possession of the land, and there will be corpses. 

If Jupiter and the other planets stand opposite one another, 
some calamity will overtake the land. If Mars and Jupiter come 
into conjunction, there will be deaths among the cattle. 

If an eclipse of the Sun take place on the twenty-eighth day of 
the month I jar, the king will have a long reign ; but, if it take place 
on the twenty-ninth day of the month, there will be corpses on the 
first day of the following month. 

If there should be thunder during the month of Tisri, a spirit of 
enmity will prevail in the land ; and if it should rain during that 
month, both men and cattle will fall ill. 

Besides these predictions, which were based upon phe- 
nomena connected with the movements of the stars and the 
conditions of the weather, there were others which the 
people themselves were competent to make without the aid 
of the professional astrologer or the official priest. Such, 
for example, are the following ** omens": — 

If a woman gives birth to a child the right ear of which is lacking, 
long will be the reign of the prince of that land. 

If a woman gives birth to a child both of whose ears are lacking, 



ORIENTAL MEDICINE 15 

sadness will come upon the land and it will lose some of its 
importance. 

If a woman gives birth to a child whose face resembles the beak 
of a bird, there will surely be peace in the land. 

If a woman gives birth to a child the right hand of which lacks 
fingers, the sovereign of that country will be taken prisoner by his 
enemies. 

The keen interest taken by the priests in the matter of 
predicting the outcome of various diseases led in due time 
to their making records of the nature, symptoms and 
progress of the latter. Although this practice was inaugu- 
rated purely for the purpose of enabling them to foretell 
with greater accuracy the probable issue of any given 
malady, it nevertheless served also to establish on a firm 
basis the custom of keeping records of the case-histories. 
Only one thing more was now needed to render this 
practice the first step in a genuine advance of medical 
knowledge; but this step could not be made in Babylonia, 
where priestcraft and superstition had struck such deep 
roots in the public life. It was only in free Greece, and at 
a time in its history when the spirit of Hippocrates exerted 
an overpowering influence over the minds of men, that the 
separation of the functions of the physician from those of 
the priest became possible and was in due time effected. 
(Neuburger.) 

Before closing this very incomplete account of the state 
of medical knowledge in Babylonia, it will be well to mention 
some of the items of the law laid down by Hammurabi 
(circa 2200 B. C.) for the guidance of the physicians of that 
land with regard to the remuneration which they should 
receive. At the same time I shall make no attempt to 
reconcile the statement of Herodotus (given on page 12) 
with the wording of this law, which distinctly recognizes 
the existence of physicians in Mesopotamia. Possibly the 
conditions in Nineveh in the fourth century B. C. were 
different from what they had been eighteen centuries 
earlier. 

If a physician makes a deep cut with an operating knife of 
bronze and effects a cure, or if with such a knife he opens a tumor 



16 GROWTH OF MEDICINE 

and thus avoids damaging the patient's eye, he shall receive as his 
reward 10 shekels of silver. If the patient is an emancipated slave, 
the fee shall be reduced to 5 shekels. In the case of a slave the 
master to whom he belongs shall pay the physician 2 shekels. 

If a physician makes a deep wound with an operating knife of 
bronze and the patient dies, or if he opens a tumor with such a 
knife and the patient 's eye is thereby destroyed, the operator shall 
be punished by having his hands cut off. 

If a physician, in operating upon the slave of a freedman, makes 
a deep wound with an operating knife of bronze and thus kills the 
patient, he shall give the owner a slave in exchange for the one 
killed. And if, in opening a tumor with such a knife, the physician 
destroys the slave's eye, he shall pay to the latter 's owner one-half 
the slave 's value. 

If a physician effects the healing of a broken bone or cures a 
disease of the intestines, he shall receive from the patient a fee 
of 5 shekels of silver.^ 

It would be difficult to imagine anything better adapted 
to arrest the development of medical knowledge in a nation 
than the promulgation of a law like that ascribed to 
Hammurabi ; and one cannot be surprised at the statement 
made by Herodotus, eighteen centuries later, ''that there 
were no physicians in Babylon. ' ' Foolhardy, indeed, would 
be the man who, for the sake of earning a possible reward 
of six shekels of silver, would be willing to risk the danger 
of having both his hands cut off; and yet every conscien- 
tious and faithful practitioner of medicine in Babylon at 
the time mentioned must necessarily have been obliged to 
run this risk. 

Medicine in Ancient Egypt. — Of the sources of informa- 
tion with regard to the knowledge of medicine possessed 
by the ancient Egyptians the most important are the 
following: Homer's Odyssey; Herodotus; Diodorus; 
Clemens of Alexandria; Pliny's Natural History; Dioscori- 

2 From the statements just quoted it appears that a certain kind of bronze 
(an alloy of copper and tin, with the addition perhaps of a little zinc) was 
used in Assyria, in the manufacture of surgical knives, as early as during the 
twenty-third century B. C. Dr. Meyer-Steineg, Professor of the History of 
Medicine in the University of Jena, Germany, assures the writer that knives 
made of this material are susceptible of being given as keen a cutting edge 



ORIENTAL MEDICINE 17 

des; the Papyrus Ebers; the Papyrus Brugsch; and the 
Papyrus Birch, in the British Museum. Then, in addition 
to these sources, there are the inscriptions found in recent 
times on the walls of the temples and the pictures painted 
on the wrappings of mummies, from both of which consid- 
erable information with regard to various therapeutic 
procedures and to the details of the process of embalming 
Has been derived. Some of this information extends back 
to about 3000 B. C. The healing art was at that time 
entirely in the hands of the temple priests, who formed an 
organized body with a sort of physician-in-chief at its head. 
Two of these — Athotis and Tosorthos — attained such a high 
standing and possessed such influence that they were chosen 
Kings of Egypt. The practice of obstetrics was entrusted 
to the care of women who had been trained to this work and 
who acknowledged the authority of a skilled head-nurse of 
their own sex. The patients who had received treatment 
for their ailments at one or other of the temples presented 
to these institutions gifts in the form of sculptured or 
painted representations of the diseased or injured parts 
of the body. In these and in other ways medicine and 
pharmacy received contributions which were of no mean 
value. Botanical gardens were established at various 
places in Egypt and were cultivated with care. Chem- 
istry — a name which derives its origin from a word in the 
Egyptian language — also made considerable progress as a 
science. On the other hand, the knowledge of the structure 
and functions of the different parts of the human body 
was very imperfect and remained unchanged for many 
centuries. This would probably not have been the case if 
the work of preparing the bodies for the process of 
embalming had not been entrusted entirely to mere menials, 
men who had no interest in anything but the mechanical 
part of their occupation. 

According to the statement of Clemens of Alexandria' 

as are those made of the best of steel. At least one such bronze knife may be 
seen in the collection of ancient surgical instruments, votive offerings, etc., 
which he is making for the benefit of the University. 

8 A Christian ecclesiastical writer who lived about the year 200 A. D. 



18 GROWTH OF MEDICINE 

the Egyptian science of medicine is set forth in the last six 
of the forty-two hermetic books, which were composed, 
according to the prevailing belief, by the god Thot or 
Thoiit (= Hermes of the Greeks). The first one of these 
six books is devoted to the anatomy of the human body, the 
second one to the diseases to which it is liable, the third to 
surgery, the fourth to remedial agents, the fifth to the 
diseases of the eye, and the sixth to diseases of women. 
As to the remedial agents, Neuburger says that it has not 
been found practicable to identify more than a very few of 
the Egyptian drugs enumerated by Dioscorides. Homer, 
who wrote at least five hundred years B. C, has something 
to say on this subject in the Odyssey.* His words are as 
follows : — 

Such drugs Jove's daughter owned, with skill prepar'd, 

And of prime virtue, by the wife of Thone, 

Aegyptian Polydamna, given her. 

For Aegypt teems with drugs, yielding no few 

Which, mingled with the drink, are good, and many 

Of baneful juice, and enemies to life. 

There every man in skill medicinal 

Excels; for they are sons of Pason^ all. 

A physician of the present age, on reading the histories 
of the ancient Egyptians, Greeks and other oriental 
nations, finds it almost impossible to realize that many of 
the characters designated as gods and goddesses, possibly 
all of them, were not mythological persons, as they would 
have been termed only a few years ago, but real human 
beings like ourselves. Such, for example, was the opinion 
of Cicero who, when asked why these people were spoken 
of as gods, gave the following reply :^ *'It was a well- 
established custom among the ancients to deify those who 
had rendered to their fellow men important services, as 

4 Lines 285-292 of Book IV. of the Earl of Derby's translation, first pub- 
lished in 1864. 

5 Pason is the same as Apollo, who was believed by the Greeks to have been 
the inventor or discoverer of the art of medicine. 

• See Le Clerc 's Histoire de la Medecine, Amsterdam, 1723. 



ORIENTAL MEDICINE 19 

Hercules, Castor and Pollux, Aesculapius, Bacchus and 
many others had done.'* And I find that those modern 
authors of the history of medicine whose works I have 
consulted, are quite ready to accept even the gods called 
by the Egyptians Osiris (or Serapis), Isis, and Thoiit 
(or Hermes) as genuine historical personages. Such a 
belief receives some degree of confirmation from the 
following inscriptions which, according to the authority of 
Le Clerc,^ were found engraved upon two columns dis- 
covered in the city of Nyoa, in Arabia : — 

(On the first column) : My father is Cronos, the youngest of 
all the gods. I am King Osiris, who have visited with my armies 
every country on the face of the earth — the remotest inhabitable 
parts of India, the regions lying beneath the Bear, the neighbor- 
hood of the sources of the Danube, and the shores of the Ocean. 
I am the oldest son of Cronos, the scion of a fine and noble race. 
I am related to the day. There is no part of the earth which I 
have not visited, and I have filled the entire universe with my 
benefits. (On the second column) : I am Isis, Queen of all this 
country, and I have been taught by Thoiit. There is nobody who 
has the power to loosen what I shall bind. I am the oldest daughter 
of Cronos, the youngest of the gods. I am the wife and at the same 
time the sister of King Osiris. To me is due the credit of having 
been the first to teach men agriculture. I am the mother of King 
Horus. I shine in the dog-star. It is I who built the city of 
Bubastis. Farewell, Egypt, my native land. 

The discovery of the art of medicine, says Le Clerc, was 
attributed to Osiris and Isis, and they were also credited 
with having taught it to Aesculapius. 

At the cities of On (Heliopolis), Sais, Memphis and 
Thebes were located the most celebrated of the Egyptian 
temples, which were dedicated not merely to the worship 
of their numerous gods, but also to the dissemination of 
knowledge of various kinds and to the care of the sick and 
maimed. In a word, they were — like the Aesculapian 
temples at Trikka, Epidaurus and Cos, of which some 
account will be given farther on — both hospitals for the 

T At bottom of p. 15 of his Riatoire de la Midecine. 



20 GROWTH OF MEDICINE 

treatment of disease and schools for the training of 
physicians. The chief priest of the temple bore also the 
title of the *' physician-in-chief , " and exercised the pre- 
rogatives of a chief magistrate. Under this system medical 
knowledge advanced to a certain stage and then made no 
further progress. The preponderance of the priestly {i.e., 
the superstitious) influence was too pronounced to permit 
anything like real progress. 

The papyrus Ebers makes mention of a number of dis- 
eases, and among them the following may be noted : abdomi- 
nal affections (probably dysentery), intestinal worms, 
inflammations in the region of the anus, hemorrhoids, 
painful disorders at the pit of the stomach, diseases of the 
heart, pains in the head, urinary affections, dyspepsia, 
swellings in the region of the neck, angina, a form of 
disease of the liver, about thirty different affections of the 
eyes, diseases of the hair, diseases of the skin, diseases of 
women, diseases of children, affections of the nose, ears 
and teeth, tumors, abscesses and ulcers. 

In the matter of diagnosis the Egyptian physicians not 
only employed inspection and palpation, but were in the 
habit of examining the urine. A statement made in the 
papyrus Ebers is good ground for the belief that they also 
employed auscultation to some extent. 

Therapeutics constituted beyond all question the strong- 
est part of Egyptian medicine. As might be expected from 
the strange mixture of the priest and the medical man in 
every physician, the remedial measures commonly employed 
consisted in part of prayers and incantations, and in part of 
rational procedures and the use of drugs. Among the latter 
class of remedies the following deserve to be mentioned: 
emetics, cathartics and clysters. Bloodletting, sudorifics, 
diuretics and substances which cause sneezing were also 
often employed in Egypt. To produce vomiting the favorite 
agents were the copper salts and oxymel of squills. Castor 
oil disguised in beer was given as an aperient. Pome- 
granate was the drug preferred for the expulsion of worms. 
Mandragora and opium were also employed as remedies. 
Foreign drugs were largely imported by the Phoenicians, 



ORIENTAL MEDICINE 21 

and in their successful campaigns against Asiatic nations 
the Egyptians learned much about the use of these rarer 
remedies. The different forms in which the Egyptians 
administered their remedies included potions, electuaries, 
gums to be chewed but not swallowed, gargles, snuffs, 
inhalations, salves, plasters, poultices, injections, supposi- 
tories, clysters and fumigations. The physicians, in their 
practice, were subjected to very strict rules regarding the 
amount of the doses to be given and the manner of admin- 
istering the different remedies, and consequently they 
received no encouragement to indulge in any individuality 
of action. The prescriptions were written in very much 
the same manner as are those of to-day; that is, they 
contained the fundamental or important drugs, certain 
accessory materials, and something which was intended 
merely to correct the unpleasant taste of the mixture. In 
comparison with those commonly written at a somewhat 
later period these ancient prescriptions were of a very 
simple character. 

Up to the present time the researches of the archaeolo- 
gists have thrown comparatively little light on the surgery 
of the ancient Egyptians. The facts already ascertained, 
however, are sufficient to warrant the statement that they 
had reached a degree of knowledge and skill in this depart- 
ment of medicine well in advance of that reached by any 
of their contemporaries. They performed the operations 
of circumcision and castration, and they removed tumors, 
and their eye surgeons were especially renowned for the 
work which they accomplished in their special department. 
Their skill in manufacturing surgical instruments is amply 
revealed in the specimens — instruments for cupping, 
knives, hooks, forceps of different kinds, metal sounds and 
probes, etc. — ^which have been dug up at the various sites 
of ancient ruins. They must also have possessed consid- 
erable manual skill, for without it they could not, in 
embalming a corpse, have removed the entire brain from 
the skull with a long hook, by way of the nasal passages, 
and at the same time have left the form of the face 
undisturbed. 



22 GROWTH OF MEDICINE 

From Joachim's German translation of the papyrus 
Ebers,* as quoted by Neuburger, I copy the following 
passages : — 

If thou findest, in some part of the surface of a patient's body, 
a tumor due to a collection of pus, and dost observe that at one 
well-defined spot it rises up into a noticeable prominence, of 
rounded form, thou should 'st say to thyself: This is a collection 
of pus, which is forming among the tissues ; I will treat the disease 

with the knife If thou findest, in the throat of a patient, 

a small tumor containing pus, and dost observe that it presents 
at one point a well-defined prominence like a wart, thou may'st 
conclude that pus is collecting at this point. ..... If thou findest, 

in a patient's throat, a fatty growth which resembles an abscess, 
but which yields a peculiar sensation of softness under the pressure 
of the finger, say to thyself: this man has a fatty tumor in his 
throat ; I will treat the disease with the knife, but at the same time 
I will be careful to avoid the blood-vessels. 

These short extracts will suffice to show that the Egyptian 
physicians of that early period — at least 1550 B. C. — 
reasoned about pathological lesions in very much the same 
manner as a physician of to-day would reason. In this 
same ancient papyrus, however, foolish as well as sensible 
statements appear. Thus, for example, mention is made 
on the one hand of the fact that, in order to give a certain 
remedy to an infant, it is sufficient to administer it to the 
nurse who suckles the child (a proceeding which is not 
uncommon in our own day) ; and then, in another part of 
the text, it is stated that ^*if, on the day of its birth, the 
infant does^ ^not cry, it will surely live ; but, if it says * ba, * 
it will die. 'J 

In matters relating to personal hygiene the ancient 
Egyptians often displayed a remarkable degree of common 
sense. They maintained, for example, that the majority 
of diseases are due to the taking of food in excessive 
quantity ; and, in harmony with this belief, they introduced 
the custom of devoting three days out of every thirty to 
the taking of emetics and clysters. Perhaps it was to this 

8 Papyros Ebers, aus dem Aegyptischen zum ersten Male vollstandig uber- 
setzt von H. Joachim, Berlin, 1890. 



ORIENTAL MEDICINE 23 

custom that they owed their good health, — a fact to which 
both Herodotus and Diodorus testify. In principle this 
practice agrees with that adopted by modern physicians, 
who omit the emetics and substitute for the clysters the 
drinking of certain mineral waters during a limited period 
of the summer season and under the very agreeable 
surroundings of a comfortable hotel at Carlsbad, Ems, 
Wiesbaden or Saratoga. While the monthly plan of 
purging the system of harmful elements must certainly 
have been the more effective of the two, it cannot for a 
moment be doubted that exceedingly few moderns would 
be willing to subject themselves to such a regime. 

In still other ways the ancient Egyptians displayed a 
most intelligent respect for every measure that tended to 
promote the general health of the community. They took 
care, for example, to prevent the entrance of decomposing 
materials into the soil and the ground water ; priests skilled 
in work of this character made careful inspections of all 
meats that were to be used for food ; stress was laid upon 
the importance of keeping the dwelling houses clean; the 
people were taught the value of bathing the body frequently, 
of cultivating gynmastic exercises, of clothing themselves 
suitably, and of employing the right sort of diet. At a still 
later period of their history they adopted the custom of 
drinking only water that had been either boiled or filtered. 
A particular kind of beer, the gift of their first king, Osiris, 
was the favorite beverage of the people. It was made from 
barley and doubtless possessed intoxicating properties, as 
is suggested by one of the papyrus texts in which the 
following charge is brought against a student: **Thou 
hast abandoned thy books and art devoting thyself to idle 
pleasures, going from one beer-house to another. Thou 
smellest so strongly of beer that men avoid thee." 

A large proportion of the sources of information regard- 
ing the medicine of the ancient Egyptians have been 
brought to light during recent years, but so many gaps in 
the series still remain unfilled that it is not possible to 
furnish more than a disconnected and very imperfect 
account. Archaeological investigations, however, are being 



24 GROWTH OF MEDICINE 

conducted with vigor and new discoveries are reported 
almost every month. There are therefore good reasons for 
hoping that, in the course of the next few years, much 
additional light will be shed on the mode of life and 
accomplishments of these pioneers of civilization, who, 
before they passed out of history, succeeded in attaining 
the highest degree of cultivation in the science and art of 
medicine that had up to that time been attained by any 
other nation. One thing is certain, says Neuburger, they 
exerted a powerful influence upon the beginning of medicine 
in Greece and upon the social hygiene of the Jewish people, 
and therefore upon the human race at large. 



CHAPTER III 
ORIENTAL MEDICINE (Continued) 

The Medicine of the Ancient Persians. — ^After Cyrus the 
Great had put an end to Babylon as a power among the 
nations the Persians became the leaders in all the affairs 
not merely of Asia Minor but also of the entire country 
from India to the shores of the Mediterranean; in fact, 
they eventually also gained control of the land of the 
Pharaohs. Notwithstanding the completeness of the 
political power which they possessed over these conquered 
races, they permitted them to retain their respective 
religions and even their individual languages ; as evidence 
of the correctness of which last statement the modern 
discovery of inscriptions written in the three principal 
tongues may be mentioned. The remarkable degree of 
general culture which existed at Babylon at the time of the 
Persian conquest, and which the Sumerians and Semites 
had originally introduced, was left undisturbed by the 
political change. 

So far as we possess any knowledge regarding the 
medicine of the ancient Persians, this information has been 
derived, according to Neuburger, from the Zend-Avesta — 
one of the ancient religious writings preserved by the 
Parsees. It furnishes comparatively few facts of special 
interest to physicians. In the main, the practice of medi- 
cine must have differed very little from that employed 
by the earliest Babylonian physicians, and briefly described 
on pages 11-16. There are one or two additional 
matters, however, which deserve to be mentioned here. It 
was maintained, for example, that the touching of a corpse 
produced a special contamination, a belief which interfered 
most seriously with the study of anatomy, and therefore 



26 GROWTH OF MEDICINE 

prevented any real advance in medical knowledge. Then, 
again, the ancient Persians appear to have taken compara- 
tively little interest in surgery, for it is said that King 
Darius I. was obliged, when he needed treatment for a 
badly sprained ankle, to send for a Greek physician. 
Finally, there may be found in Herodotus the following 
statement, which shows that the Persians had learned 
something of value, in practical hygiene, from their 
neighbors, the Egyptians: — 

The Great King (Cyrus), when he goes to the wars, is always 
supplied with provisions carefully prepared at home, and with 
cattle of his own. "Water, too, from the river Choaspes, which flows 
by Susa, is taken with him for his drink, as that is the only water 
which the kings of Persia taste. "Wherever he travels, he is 
attended by a number of four-wheeled cars drawn by mules, in 
which the Choaspes water, ready boiled for use, and stored in 
flagons of silver, is moved with him from place to place.^ 

Neuburger makes the remark that the ancient Persians 
are entitled to the gratitude of later generations for the 
valuable service which they rendered the science of medi- 
cine, inasmuch as, during the dynasty of the Sassanide 
princes (fifth century A. D.) and at a time when European 
culture was hastening to its destruction, they gave shelter 
both to classical culture in general and to the medical 
knowledge of the Greeks, and then afterward handed it 
over to the conquering Arabs, who passed it on to our 
forefathers. 

The Medicine of the Old Testament. — There are no 
medical writings which give any information concerning 
the science and art of medicine as possessed by the ancient 
Israelites, but the Bible contains a number of passages that 
refer to matters which belong in the domain of medicine, 
and more particularly in that of social hygiene. The mosaic 
laws were framed with a view to the good of the Jewish 
people as a whole, and were directed to such matters as 
the prevention and suppression of epidemic diseases, the 
combating venereal affections and prostitution, the care 

1 Book I., p. 96, of George Eawlinson 's translation. 



ORIENTAL MEDICINE 27 

of the skin, the systematizing of work, the regulation of 
sexual life, the intellectual cultivation of the race, the 
provision of suitable clothing, dwellings and food, the use 
of baths, etc. Many of these laws — like those, for example, 
which prescribe rest on the Sabbath day, circumcision, 
abstinence from eating the flesh of the pig, the isolation of 
persons affected with leprosy, the observation of hygienic 
rules in camp life, etc. — testify to a remarkably high degree 
of the power to reason correctly; and, when considered in 
the light of modern science, they seem to justify the pre- 
diction made in Deuteronomy iv., 6. A similar prediction 
(supposed to be spoken by God from Mount Sinai) is made 
in Exodus xix., 6: ''And ye shall be unto me a kingdom 
of priests, and an holy nation. ' ' That a large part of the 
credit given to Moses for the wisdom displayed in these 
sanitary laws really belongs to the Egyptians is shown by 
the text of Acts vii., 22: ''And Moses was learned in all 
the wisdom of the Egyptians, and was mighty in words and 
in deeds." 

As regards the manner in which the Israelites treated 
the diseases which afflicted them the Bible furnishes ample 
proof of the fact that they placed their chief reliance upon 
prayers, sacrifices, and offerings at their temples, and 
made comparatively small use of medicinal agents, dietetic 
measures, and external applications. The favorable effect 
of David 's harp-playing upon the melancholia of King Saul 
furnishes the only instance, to be found in the Bible, of the 
curative value of music in certain mental disorders. 

The story of Naaman (2 Kings v.) deserves to be 
mentioned briefly here. He was captain of the host of the 
King of Syria (about 894 B. C.) and a man of valor, highly 
esteemed by his master, but he was — according to the Bible 
statement — a leper. Learning casually that there was in 
Samaria a prophet who might be able to cure his disease, 
he put a large sum of money into his sack and departed for 
that country. "So Naaman came with his horses and with 
his chariot, and stood at the door of the house of Elisha. 
And Elisha sent a messenger unto him, saying. Go and 
wash in Jordan seven times, and thy flesh shall come again 



y~ 



28 GROWTH OF MEDICINE 

to thee, and thou shalt be clean." Naaman, at first much 
displeased with the advice given to him by Elisha, and 
especially by the very informal manner in which it had 
been communicated to him, finally decided to follow the 
prophet's instructions. *^Then went he down, and dipped 

himself seven times in Jordan, and his flesh came 

again like unto the flesh of a little child, and he was clean. 

And he returned to the man of God, and came, and 

stood before him; and he said. Behold, now I know that 
there is no God in all the earth, but in Israel: now there- 
fore, I pray thee, take a blessing of thy servant." Elisha, 
however, refused persistently to accept any reward for the 
advice which he had given. He simply said to Naaman: 
**Go in peace." Before he departed, however, Naaman 
expressed to Elisha the hope that he would be pardoned 
if he yielded to the necessity of bowing down to the god 
Rimmon on certain occasions — as, for example, when he 
accompanied his master, the king, on his visits to the 
temple of that god for the purposes of worship. From the 
evidence furnished by this account, as given in the Old 
Testament, it is fair to assume that both Naaman and the 
writer of the book of Kings believed that the cure had been 
effected by supernatural means. The modern physician, 
however, is not ready to accept such an interpretation of 
the manner in which Naaman 's cure was effected, but 
prefers to believe that the supposed leprosy was in reality 
some curable form of skin disease which to the unprofes- 
sional eye appeared like the other malady. It might, for 
example, have been an aggravated general eczema, depend- 
ent upon such excesses of eating and drinking as a wealthy 
captain of the king's host would be likely to indulge in. 
And if this supposition is correct, one cannot but admire 
the great practical wisdom of Elisha in advising Naaman 
to take seven baths — one a day presumably — in the river 
Jordan, a spot so far removed from his home that it would 
scarcely be possible for him to obtain any but the simplest 
kind of diet during this comparatively long period of time. 
An interesting case of snake-bite is briefly related in 
Acts xxviii., 3-6. It is stated that ''when Paul (after being 



ORIENTAL MEDICINE 29 

shipwrecked on the Island of Melita) had gathered a bundle 
of sticks, and laid them on the fire, there came a viper out 
of the heat, and fastened on his hand. And when the 
barbarians saw the venomous beast hang on his hand, they 
said among themselves, No doubt this man is a murderer, 
whom, though he hath escaped the sea, yet vengeance 
suffereth not to live. And he shook off the beast into the 
fire, and felt no harm. Howbeit they looked when he should 
have swollen, or fallen down dead suddenly : but after they 
had looked a great while, and saw no harm come to him, 
they changed their minds, and said that he was a god.'* 
This narrative is interesting in several respects, but there 
is one feature that deserves to receive special mention, viz., 
the fact that Paul experienced no harm from the bite of a 
poisonous serpent — a wound which frequently proves fatal. 
Inasmuch as the account distinctly states that the reptile 
** fastened on his hand" and that *Hhe barbarians saw the 
venomous beast hang on his hand," the conclusion is war- 
ranted that one or both of the creature 's fangs had entered 
the hand by a curving route, and probably in such a manner 
that the free end of each fang, from which the poison is 
ejected, passed completely through the skin from within 
outward. When the bite of a poisonous snake is of a 
character such as I have just described, — and not a few 
of them have this character, — only a very small quantity 
of the venom is lodged in the subcutaneous tissues, where 
the larger blood- and lymph-channels lie, and as a conse- 
quence the person bitten escapes serious harm. On the 
other hand, when the fangs enter the flesh in a less decidedly 
curving direction, thus permitting a greater quantity of 
the venom to reach and remain in the deep-lying tissues, 
serious or even fatal results may be anticipated. The point, 
then, which I desire to make is simply this: Paul's escape 
from death in this instance may perfectly well be ascribed 
to natural causes. 

The Israelites, at a certain stage of their history, appear 
to have completely divorced the practice of medicine from 
the priestly function. In one place, for example, it is stated 
that King Asa sought relief from his ailment, not from 



30 GROWTH OF MEDICINE 

Jehovah, but from the physicians. Jeremiah expresses 
astonishment that not a single physician is to be found in 
Gilead. May this not be interpreted as signifying that 
regularly established physicians were at that time (595 
B. C.) to be found in some parts of Palestine? And, at a 
much earlier period (1500 B. C), Job calls his friends 
''physicians of no value" (Job xiiL, iv.). From these and 
a number of other statements in the Bible it seems per- 
missible to believe that, at a very early period of history, 
the Jewish physicians occupied an entirely independent 
position. 

It would doubtless appear strange to most readers of 
this brief sketch of the history of medicine if some refer- 
ence were not made in this place to Luke, the author of the 
gospel which bears his name and of the Acts of the 
Apostles, and who was also the companion of Paul on his 
journey to Rome and during a portion of the latter 's stay 
in that city. Luke was a native of Antioch, in Syria, and 
not a Jew. He was a physician and tradition says that he 
was also a painter. It is not known where he received his 
medical training, but it is not at all unlikely that he studied 
at Alexandria, in Egypt, where the greatest facilities for 
such training, obtainable at that period, were to be found. 
His style of writing shows plainly that he was a man of 
considerable cultivation and endowed with a clear and 
logical mind ; and if he had not possessed a genial person- 
ality he would hardly have been known as "the beloved 
physician"; nor could any other motive but those of loyal, 
self-sacrificing friendship for his friend, and a desire to 
promote the cause of Christianity, have led him to share 
with Paul the dangers and discomforts of the journey to 
Rome. 

The Medicine of India, China and Japan. — It would be 
too much of a departure from the plan which is being 
followed in the writing of this history to attempt to 
describe, even in the briefest manner, the mode of develop- 
ment of the science and art of medicine in India, China 
and Japan. Unquestionably the earlier physicians of 
these countries made many valuable contributions to 



ORIENTAL MEDICINE 31 

medical knowledge, but they were made at such a period 
of time, or under such conditions, that they could not have 
exerted an appreciable influence upon the development of 
medicine in ancient Greece, — certainly no such influence as 
was exerted by Assyria and Persia, and especially by 
Egypt. It therefore seems permissible to speak of the 
medicine of these more remote countries only incidentally, 
and not as an integral part of the series of centres of 
learning which made the medicine of ancient Greece the 
direct ancestor — if I may use such a term — of European 
medicine.^ In conformity with this idea it will be well to 
mention here briefly a few of the more important facts 
relating to the achievements of the physicians of the three 
countries named. 

The most celebrated medical authors in India were 
Caraka, Siisruta and Vagbhata — *'The ancient trinity," 
as they were called. Caraka probably lived during the 
early part of the Christian era, Susruta during the fifth 
century, and Vagbhata not later than during the seventh 
century A. D. It is apparent, therefore, that none of the 
treatises written by these authors could have exerted the 
slightest influence upon the growth of medical knowledge 
in ancient Greece. 

The crudeness of many of the conceptions held by these 
Hindu physicians concerning pathology is revealed in the 
following definition : ' ' Health is the expression of the 
normal composition of the three elementary substances 
(air, mucus and bile) which play a vital part in the 
machinery of the human body, and it is also dependent 
upon the existence of normal quantitative relations between 
these three substances; and when the latter are damaged, 
or when they are abnormally increased or diminished, then 
disease of one kind or another makes its appearance.'" 

2 Neuburger speaks of the growth of medical knowledge in India as a 
development that ran parallel with that of ancient Greece. 

3 From Neuburger. — Equally crude are their ideas respecting the causes of 
disease, as shown by the following items selected from quite a long list of 
etiological factors: errors in diet and in the habits of life, climatic influences, 
psychic factors, heredity, poison, supernatural influences like the anger of the 



32 GROWTH OF MEDICINE 

Great stress was laid by the physicians as well as by the 
priests of ancient India upon the observance of very 
elaborate rules respecting the care of the person while in 
health and, very naturally, when a patient became ill the 
physician in charge paid quite as much attention to the 
employment of hygienic and dietetic measures in effecting 
the desired cure as to the administering of drugs. 

The list of the commonly employed hygienic measures is 
too long for reproduction in its entirety in this brief sketch, 
but an enumeration of some of the more important items 
may prove interesting. In estimating the value of these 
rules the reader should bear in mind that they were 
intended for people living in a hot climate. Daily bathing 
heads the list. Then follow: regulation of the bowels; 
rubbing the teeth with fresh twigs of certain trees which 
possess astringent properties, and also brushing them twice 
a day ; rinsing the mouth with appropriate washes ; rubbing 
the eyes mth salves; anointing the body with perfumed 
oils; cutting the nails every five days, etc. Two meals a 
day were prescribed — the first one between nine in the 
morning and noon, and the second between seven and ten 
in the evening. * ' Only a moderate amount of water should 
be drunk during the meal ; drinking water at the beginning 
of a meal delays digestion, while a copious draught at the 
end produces obesity. After the meal the mouth should be 
carefully cleansed and a short walk should be taken." 
Among the more important articles of food the following 
deserve to be mentioned: rice, ripe fruit, the ordinary 

gods, the evil powers of demons, etc. For purposes of diagnosis the earlier 
Indian physicians utilized not only inspection, palpation and auscultation, but 
also the senses of taste and smell. They noted the losses and increases in the 
weight of the body, changes in the appearance of the skin, the tongue and the 
excretions, alterations in the configuration of the body, the form and other 
characteristics of swellings, etc. They also noted changes in the patient's 
voice, in the character of the breathing, in the noises accompanying movements 
of the joints and the twistings of the intestines. The crepitus caused by the 
rubbing together of the roughened ends of a fractured bone did not escape 
their notice. At a later period, doubtless through the influence of the teachings 
of foreign physicians, they attached great importance to the examination 
of the pulse. 



ORIENTAL MEDICINE 33 

vegetables, ginger, garlic, salt, milk, oil, melted butter, 
honey and sugar cane. If meat is eaten, preference should 
be given to venison, wild fowl and the flesh of the buffalo. 
The meat of the pig, and beef, as well as fish, are less 
conducive to health. Gymnastic exercises in moderation 
are beneficial. Sleep should be indulged in during the day 
only after some specially severe exercise ; at night it should 
not be extended beyond one hour before sunrise. Bathing 
immediately after eating is harmful, and it is not to be 
indulged in when one is affected with a cold, with a high 
fever, with diarrhoea, or with some disease of the eyes 
or ears. A hot bath or washing with warm water may be 
beneficial for the lower half of the body, but for the upper 
half it is harmful. Sea bathing and cold baths (preferably 
in the river Ganges) are beneficial. The clothing worn 
should be clean ; soiled garments are likely to produce skin 
diseases. It is advisable to wear shoes, and an umbrella 
or a staff should be carried. The wearing of garlands, 
finery, and jewels increases the vital powers and keeps 
away evil spirits. The following are good measures to 
adopt for the preservation of health: an emetic once a 
week; a laxative once a month; and a bloodletting twice 
a year. All the measures enumerated above were subject 
to modification according to changes in the season, the 
locality, the weather, and various other circumstances. 

In harmony with the extraordinary fruitfulness of the 
land the pharmacopoeia of India is very rich. It is a 
remarkable fact that not one of the nupaerous drugs 
mentioned in the official list is of European origin. The 
great majority of them belong to the vegetable kingdom; 
Caraka stating that he knew of 500 plants that possessed 
remedial virtues, while Siisruta placed the number at 760. 
Then, too, the list contains a goodly number of drugs which 
belong, some to the animal and others to the mineral king- 
dom. It appears that the physicians of India began using 
mineral substances, both externally and internally, at a 
very early period of their history. Among such substances 
the following may be mentioned: sulphate of copper, 
sulphate of iron, sulphate of lead, oxide of lead, sulphur. 



34 GROWTH OF MEDICINE 

arsenic, borax, alum, potash, chloride of ammonium, gold, 
precious stones of different kinds, etc. The people of India 
were skilled in chemical and pharmaceutical work. The 
drugs were prepared by them in a great variety of ways — 
as, for instance, extracts of the juices of plants, infusions, 
decoctions, electuaries, mixtures, syrups, pills, pastes, 
powders, suppositories, collyria, salves, etc. Practicing 
physicians carried with them a sort of portable medicine 
chest, and they often collected, themselves, the medicinal 
plants which they required. Susruta gives instructions as 
to the spots where certain plants are most likely to be 
found, and as to the seasons when they should be gathered. 
Charlatanry and mysticism often played a part in this 
business. Thus, it was maintained that drugs collected and 
prepared by persons other than physicians did not produce 
the desired effects. The fact that cosmetics (especially 
hair dyes), ''elixirs of life," aphrodisiacs, poisons and 
antidotes for poisons, occupy the most prominent place in 
the list of pharmaceutic preparations sold, casts a glaring 
ray of light, as Neuburger states, on the degree of culture 
among the people of ancient India. 

The list of separate maladies recognized by the physi- 
cians of the latter country is inordinately long. There 
were 26 kinds of fevers, 13 species of swellings of the lower 
abdomen, 20 different diseases due to worms, 20 kinds of 
urinary diseases, 8 varieties of strangury, 5 kinds of 
jaundice, 5 varieties of cough or asthma, 18 kinds of 
''leprosy," 6 kinds of abscesses, 76 different eye diseases, 
28 affections of the ear, 65 disorders of the mouth, 31 nasal 
affections, 18 diseases of the throat, a large number of 
mental disorders, etc. It seems scarcely necessary to 
remark that these so-called diseases were in reality only 
groups of certain types of loosely related symptoms. The 
term "leprosy," for example, included, besides the disease 
which modern physicians call by that name, a number of 
different affections of the skin. It is worth noting here 
that diabetes mellitus, which is one of the twenty different 
kinds of urinary diseases enumerated in the classified list 
mentioned above, was first described by the physicians of 



ORIENTAL MEDICINE 35 

India, whose attention was directed to the disorder by 
observing that flies and other insects were attracted to the 
urine of these patients by reason of its sweetness. It is 
also an interesting fact that occasionally these physicians, 
who, beyond a doubt, were keen observers of symptoms, 
paid some attention to the anatomical features of the 
individual cases. Thus, it is stated that the particular 
form of swelling of the lower abdomen, to which they 
applied the name ''splenic belly," is dependent upon *'an 
enlarged spleen which distends the left side, is as hard as 
a stone, and is arched like the back of a turtle"; whereas 
they spoke of *'an enlargement of the liver" when very 
much the same conditions were observed on the right side 
of the abdomen. The accuracy of their clinical observations 
is particularly noticeable in their accounts of cases of 
consumption, apoplexy, epilepsy, hemicrariia, tetanus, 
rheumatism, venereal diseases, some affections of the skin, 
and insanity. It was in their surgical technique, however, 
that the physicians of ancient India were distinguished 
above all their brethren of the neighboring oriental 
countries, and this superiority they maintained for a very 
long time. Among the operations which they performed 
the following may be mentioned : they removed tumors by 
excising them, they opened abscesses by the use of the 
knife, they employed scarifications (in inflanmiations of 
the throat) and made punctures (in hydrocele and ascites), 
they passed probes into fistulae, they extracted foreign 
bodies, and they employed needles armed with hairs taken 
from the horse's tail or with thread composed of flax or 
hemp. According to Susruta their stock of instruments 
was composed of 101 blunt and 20 cutting instruments. 
Among those which were blunt there were forceps of 
different sizes and forms, hooks, tubes, probes or sounds, 
catheters, bougies, etc. They made use of the magnet for 
drawing out foreign bodies of iron, and they applied cups 
for therapeutic purposes. Their cutting instruments con- 
sisted of knives, bistouris, lancets, scissors, trochars, 
needles, etc. Steel was the metal of which they were made ; 
for the people of India learned at a very early period how 



36 GROWTH OF MEDICINE 

to make steel. In suitable cases cauterization, either with 
the actual cautery or with caustic potash, was a favorite 
method of treatment with the surgeons of ancient India. 
"Burning with the heated iron," they taught, ''is more 
effective than cauterization with potash, inasmuch as it 
permanently cures diseases which may not be cured by 
either drugs, surgical instruments, or chemical cauterizing 
agents." In cases of enlargement of the spleen they 
plunged red-hot needles into the parenchyma of the organ, 
presumably through the skin and other overlying tissues. 
There were fourteen different kinds of surgical dressings ; 
cotton, woolen, linen and silk being the materials used for 
bandages, and strips of bamboo or some other wood for 
splints. When the conditions permitted such a proceeding, 
it was customary to sew up wounds of the head, face and 
windpipe. Furthermore, it was the rule to perform all 
surgical operations at a time when the constellations were 
favorable. Religious ceremonies were performed both 
before the operation and after it was completed, and it was 
also considered necessary that the operator should face 
the west and the patient the east. Intoxication was 
employed as a means of securing narcosis. Owing to their 
scrupulous cleanliness and the minute attention which they 
paid to details, the surgeons of ancient India obtained for 
a long time a much higher degree of success than did the 
surgeons of other oriental nations. At the same time they 
were not lacking in that degree of boldness which enables 
an operator — in critical cases which probably without such 
prompt and radical action would terminate fatally — to save 
life. For example, they did not hesitate to open the 
abdominal cavity and to sew up a wound in the intestines ; 
they cut for stone in the bladder, employing for this purpose 
the lateral method of operating; and they performed a 
great variety of plastic operations. 

Some of their hygienic rules concerning pregnant and 
nursing women are eminently practical; others would 
hardly be approved by modern accoucheurs. Here are a 
few of these rules: During the period of a woman's 
pregnancy close attention should be paid to her diet, and 



ORIENTAL MEDICINE 37 

special care should be exercised by her to avoid excesses 
or errors of any kind. When the ninth month is reached 
she should take up her abode in the small cottage in which 
she is eventually to be confined — a building erected with 
special religious ceremonies and thoroughly fitted with 
everything that is likely to conduce to her comfort. At the 
time of the actual confinement she should have with her 
four female assistants, and all those measures, of either a 
religious or a practical character, which have in view the 
hastening of the birth of the infant, should be scrupulously 
carried out. If any delay in the delivery of the after-birth 
occurs, the removal of the mass may be promoted by the 
employment of well-directed pressure over the lower part 
of the abdomen, by shaking the body, and also, if necessary, 
by giving an emetic. The woman in childbed should not be 
allowed to get up before the tenth day after her confine- 
ment, and for a period of six weeks her diet should be most 
carefully watched. On the third day the child should be 
put to the mother's breast; up to that time it should be 
given only honey and butter. If the mother, for any 
reason, is not able to suckle the infant, a wet-nurse should 
be employed for the purpose, but not until the physician 
shall have subjected her to a most thorough examination 
and shall have instructed her minutely in regard to her 
own diet. The subsequent care of the child was provided 
for in the most particular manner : It was restricted to a 
carefully planned diet; it was not allowed to sit or to lie 
except in certain prescribed positions ; its times for sleep- 
ing were strictly ordered ; it was permitted to amuse itself 
only in certain ways; — in brief, everything was done 
according to strict rules, even special precautions being 
taken to guard the child, during the first years of life, 
against dangerous demons. Weaning began after the 
sixth month, and for a certain length of time the child was 
fed largely on rice. In cases of difficult labor and in their 
gynaecological practice the physicians of ancient India did 
not manifest any special knowledge or skill. 

One of the instructions given to young physicians in 
India when they were about to enter upon the practice of 



38 GROWTH OF MEDICINE 

their profession, may be of interest to the reader. It is 
worded as follows: ''Let thy hair and finger nails be cut 
short, keep thy body clean, put on white garments, wear 
shoes on thy feet, and carry a staff or umbrella in thy hand. 
Thy demeanor should be humble, and thy heart pure and 
free from deceitf ulness. ' ' The following proverb, although 
it originated in India, is well worthy of acceptance in every 
part of the world: ''When you are ill the physician will 
be to you a father; when you have recovered from your 
illness you will find him a friend; and when your health 
is fully re-established he will act as your protector." 

On a previous page the statement has been made that 
the science and art of medicine developed in ancient Greece 
quite independently of any influence that might have been 
exerted by the teachings of the physicians of India. This 
statement should be somewhat modified, for it is reasonable 
to suppose, although directly confirmatory evidence has 
not yet been discovered, that, through the channels of trade 
between the two countries, some knowledge of the doings 
of the physicians of India must have reached the ears of 
their Greek brethren. On the other hand, at a later period 
of history (after Alexander the Great had invaded India), 
the relations between the two countries became quite close 
and were kept up without a break for several hundred 
years. During the earlier part of this later period, as 
appears from the writings of Hippocrates, Dioscorides and 
Galen, various drugs and methods of treatment employed 
by the physicians of India were adopted by the practitioners 
of Greece. 

Medicine of the Chinese and Japanese. — The isolation 
of China with respect to those countries which were within 
comparatively easy reach and in which there was a civiliza- 
tion that, already several thousand years before the 
Christian era, had attained a remarkable degree of 
development (India, Babylonia and Egypt, for example) ; 
her blind belief in authority ; her unwillingness to tolerate 
any influences that seemed to emanate from foreigners; 
and her complete satisfaction with her own methods of 
doing things, with her own beliefs, and with her own 



ORIENTAL MEDICINE 39 

natural and manufactured products, — these, it is generally 
believed, were the most important factors in keeping this 
remarkable nation in a state of immobility as regards at 
least some departments of human knowledge and accom- 
plishment. This is particularly true in respect of the 
science and art of medicine. But China is at last waking 
up from this lethargic state. A wonderful change has come 
over her during the past twenty or thirty years, and she 
is now beginning to realize that, with her millions of 
population and wonderful natural resources, she has an 
important part to play in advancing the civilization of the 
world. 

The preceding remarks must not be interpreted as 
signifying that, during the long ages of the past, China has 
not been developing and is not able at the present time to 
show a record of very creditable work accomplished in 
many departments of human activity. In her early history, 
many centuries ago, she accomplished great things, and 
all — so far as we now know — ^without aid from neighboring 
nations; but there came a time when all this creative 
activity ceased, and then, for long periods of years, she 
appeared to rest satisfied with the advances which she had 
already made, and to have no further ambition to add to 
the stock of her possessions. 

Among the valuable things which should be credited to 
the Chinese are the following: the discovery of the compass 
(about 1100 B. C), the making of porcelain, the invention 
of printing, the raising of silkworms, the manufacture of 
glass and of paper, the successful dyeing with purple, 
embroidering with gold, working in metals, the artistic 
cutting of precious stones, enameling, the making of * ' India 
ink," etc. Furthermore, it is a fact most creditable to the 
Chinese that in no other country in the world have scholars 
been held in such high esteem, or assigned so high a rank, 
as they have been and still are in China. 

Chinese medicine possesses a very rich literature. The 
first medical treatise, which deals with plants that possess 
medicinal virtues, is ascribed to the Emperor Schin-Nung, 
who flourished about 2800 B. C. This is the monarch who 



40 GROWTH OF MEDICINE 

taught his people from which springs they should drink, 
and who tested all the plants of his vast empire with 
reference to their healing properties. According to the 
legend the wall of his stomach was so thin that he could 
look through it and see everything that was going on in the 
interior of that organ. In this way he was able to carry 
on a large series of experiments upon himself in regard 
to the action of different poisons and their antidotes. It 
is also related that medical knowledge was still further 
advanced by the yellow Emperor Hoang-Ti who lived about 
2650 B. C, and who is credited by the Chinese with having 
invented arithmetic and music. The treatise called ''Noi- 
King," which deals with the subject of internal diseases 
and gives a systematic account of human anatomy, is also 
credited by the Chinese to this monarch; but Neuburger 
maintains that this book, which is still in common use in 
China, is of much more recent origin. There are several 
other medical treatises which deserve to be mentioned. 
Such, for example, are the following: the celebrated book 
on the pulse, written by Wang-Schu-Scho in the third 
century B. C. ; two very important books written by Cho- 
Chiyu-Kei — one bearing the title ''Schang-Han-Lun" (On 
Fevers) and the other that of ''Kin-Kwei" (Golden 
Casket) ; — the different treatises written by Tschang-Ki 
(tenth century A. D.) and published in the collection called 
**The Golden Mirror of the Forefathers in Medicine" (I- 
Tsung-Kin-Kien") ; and, finally, the very popular modern 
work (in forty volumes) entitled ^'The Trustworthy Guide 
in the Science and Art of Medicine" ('*Ching-Che-Chun- 
Ching"). Of these forty volumes, seven are devoted to 
nosology, eight to pharmacy, five to pathology, six to 
surgery, and the remainder to children's and women's 
diseases. 

Anatomy, it appears, has never played other than a very 
insignificant part in the Chinese system of medicine. This 
is not to be wondered at when we remember that their 
religion makes the dissection of a human body a sin worthy 
of punishment. No mutilated person, the Chinese believed, 
would be permitted, upon reaching the domain of the dead, 



ORIENTAL MEDICINE 41 

to rejoin Ms ancestors. About the year 1700 A. D. the 
Emperor Kang-Hi made the attempt to incorporate 
anatomy as a part of the regular study of medicine in 
the Chinese Empire ; his first step being the authorization 
of P. Perennin, a Jesuit Father, to translate Dionis' work 
on anatomy into the Chinese. His efforts were, however, 
unsuccessful, owing to the strong opposition offered by the 
native physicians. And the attempts made during more 
recent times to accomplish the desired reform by intro- 
ducing copies of European anatomical illustrations do not 
appear, as yet, to have produced any appreciable impres- 
sion. In very recent years, however, the medical mission- 
aries, sent out, if I am rightly informed, from the United 
States, are giving excellent instruction in anatomy. 

Physiology, as taught by the Chinese, is something 
beyond the comprehension of modern Europeans. Neu- 
burger explains their views in the following manner: 
''The cosmos is the product of the combined action of two 
dissimilar forces — the male (Yang) and the female (Yin). 
When these forces work in harmony a state of equilibrium 

results Matter consists of five elements, viz., 

wood, fire, earth, metal, and water; and all things are 
composed of these elements. In sympathetic relationship 
with these five elements stand the five planets (Jupiter, 
Mars, Saturn, Venus, Mercury), the five different kinds of 
air (wind, heat, moisture, dryness, cold), the five quarters 
of the globe (east, south, west, north and the equator), 
the five periods of the year (in addition to the four which 
we recognize, the Chinese make a fifth period out of the 
last eighteen days of spring, summer, autumn and winter), 
the five times of day, the five colors (green or blue, red, 

yellow, white and black), the five musical tones, etc 

As in the cosmos, so in man the two primeval forces — 
Yang and Yin — underlie all his vital processes. Thus, his 
body is made up of the five elements of which all matter is 
composed, and health depends upon the maintenance of 
a state of equilibrium between the male and the female 
forces, etc." After this brief exposition it seems unneces- 



42 GROWTH OF MEDICINE 

sary to devote any further space to the consideration of 
the physiological doctrines of the Chinese. 

With respect to the questions of diagnosis and prognosis 
it may be stated that the Chinese attach great importance 
to the necessity of making a most careful objective exami- 
nation of the entire body; but, when one investigates the 
precise manner in which this examination is to be carried 
out, it soon appears that most of the details relate to 
matters of a purely fanciful or mystical nature. The only 
steps of real importance, according to them, are the exami- 
nation of the patient's pulse and the inspection of his 
eyesight and his tongue. From the examination of the 
pulse alone they believe it possible to diagnose the nature 
and seat of the disease. To examine the pulse properly is 
a complicated affair and can scarcely be carried out in 
actual practice in less time than ten minutes; indeed, in 
certain cases the physician may find it necessary to devote 
two or three hours to the business. According to the 
Chinese scheme there are many different kinds of pulse, 
and there are no less than thirty-seven different types of 
condition presented by the tongue, each bearing its own 
special pathological significance. 

Disease, so reads the Chinese doctrine, is a discord, a 
disturbance of equilibrium, caused by the preponderance 
of one or the other of the primeval forces (the male or the 
female). It manifests itself in some disorder of the 
circulation of the vital air and the blood, and eventually 
involves the organs of the body. Wind, cold, dryness, 
moisture, the emotions and passions, poisons, and also evil 
spirits and imaginary beasts are the causes of disease. 

No other nation, says Neuburger, has at its command 
such a large number of remedial drugs; and it is also a 
fact, he adds, that the department of therapeutics is that 
in which Chinese medicine has reached its highest develop- 
ment. The steadfast belief that in nature there exists a 
remedy for every human ill led the physicians of that 
country to search diligently in all possible directions for 
vegetable and animal and also, to some extent, mineral 
substances which might possess remedial virtues. Although 



ORIENTAL MEDICINE 43 

this search necessarily brought to notice a lot of useless 
drugs, it cannot be denied that eventually it added a 
considerable number of remedies which have proved useful 
to the medical profession of the entire world. In this 
category belong the following: rhubarb, pomegranate root 
as a cure for worms, camphor, aconite, cannabis, iron (for 
the relief of anaemia), arsenic (for malarial and skin 
diseases), sulphur and mercury (both of these for affections 
of the skin), sodium sulphate, copper sulphate (as an 
emetic), alum, sal ammoniac and musk (for nervous 
affections). Toward the middle of the sixteenth century 
A. D. there was published, under the title ''Pen-Tsao- 
Kang-Mu," a monumental work (fifty-two volumes) in 
which are very fully described no fewer than 1800 remedies, 
mostly of a vegetable nature. Prophylactic Inoculation 
with the pus from a smallpox pustule was practised by the 
Chinese as long ago as during the eleventh century A. D., 
''thus constituting a forerunner of our modern serum 
therapy." (Neuburger.) Vaccination was not introduced 
into China until during the nineteenth century of the 
present era. It is a curious fact that, in the choice of a 
remedy, the Chinese physicians attach a certain degree of 
importance to the form and color of the drug, as symbols 
indicative of the effect which they may be expected to 
produce. Thus, the red blossoms of the hibiscus plant are 
believed to be more efiicacious than the white as an 
emmenagogue; saffron, being of a yellow color, possesses 
the power to relieve jaundice; beans that have the shape 
of a kidney should be prescribed in cases of renal disease ; 
glow-worms should form a part of all eye-washes, etc. 

The doses prescribed are very large, and the medicines 
are often put up in an attractive form, with labels on which 
such descriptive titles as these are written: ''Powders of 
the Three very wise Men," or "Powders recommended by 
Five Distinguished Physicians" — titles which are calcu- 
lated to work upon the imagination of the patient. 

There are two methods of treatment which the Chinese 
physicians are very fond of employing for the relief of a 
great variety of diseases — viz., acupuncture and cauteriza- 



44 GROWTH OF MEDICINE 

tion of the skin over the seat of the malady by means of 
what are termed *'moxae" — moxibustion. Moxae are pre- 
pared by kneading together into a cone-shaped, tinder-like 
mass the leaves of the artemisia vulgaris, then drying it 
thoroughly. Such a mass is attached to the skin at the 
affected spot by simply moistening the base of the cone, 
after which the apex is ignited. Some physicians prefer 
to interpose a thin sheet of metal between the skin and the 
base of the moxa. The manner in which these contrivances 
should be used in the different diseases and the proper 
number to employ are matters subject to fixed rules. In 
a strong individual, for example, as many as fifty moxae 
may be used at a time. In affections of the chest they were 
applied to the patient's back, in diseases of the stomach 
to the shoulders, and in venereal affections over the spinal 
column. In acupuncture, which is a procedure invented 
by the Chinese, slender needles of gold, silver or highly 
tempered steel, from 5 to 22 centimetres (2 in.-8% in.) in 
length, were forced through the stretched skin to different 
depths (1% in.-134 in.) and then driven farther inward in 
a rotary direction by means of a small hammer. The 
needles, after being allowed to remain in situ for a few 
minutes, were withdrawn, and pressure was made with 
the hand over the small wounds, or a moxa was burned 
over the spot. There are in all 388 places where acu- 
puncture may be performed, and a chart of the body, 
showing where these places are located, has been prepared 
for the guidance of the Chinese physicians. Neuburger 
calls attention to the fact that the latter dislike the sight 
of blood, and that this is one of the reasons why acupunc- 
ture and the use of moxae have grown to be such popular 
remedies. Bloodletting is rarely employed by them; but 
dry cupping, on the contrary, is a favorite procedure in 
certain maladies. Massage is generally performed by old 
or blind women, and much attention is devoted to the 
''movement cure," which is said to have been invented 
about 2500 B. C. 

As may readily be imagined, the Chinese — owing to 
their dislike for the sight of blood and also by reason of 



ORIENTAL MEDICINE 45 

their ignorance of anatomy — ^have not advanced, in sur- 
gery, beyond the most primitive state of that art. 

The science of public health is quite unknown in China. 
In a Chinese treatise entitled ''Long Life," the following 
advice is given: ''Always rise early in the morning, take 
some breakfast before you leave your residence, drink a 
little tea before eating, at the mid-day meal partake of 
well-cooked but not too highly salted food, eat slowly, take 
a nap of two hours after the meal, eat lightly at night, and, 
before going to bed, rinse your mouth with tea and 
have the soles of your feet rubbed until they are warm." 
(Neuburger.) 

Up to the latter part of the nineteenth century of the 
present era, Japan, so far as medical matters are con- 
cerned, differed in no material respect from China. During 
the last fifty or sixty years, however, — that is, since the 
visit of Commodore Perry, of the United States Navy, to 
that country, — wonderful changes have taken place; and 
now Japan, as a result of her determination to adopt the 
methods of education, of utilizing steam and electric power, 
etc., has already taken a leading place in the council of 
nations. The physicians, many of whom received their 
training in the best schools of Europe and the United 
States, are contributing to-day their full share toward 
advancing the science of medicine. That China is fol- 
lowing in the footsteps of Japan is already plainly evident, 
and no intelligent observer entertains the slightest doubt 
of her ultimately — probably at no distant day — possessing 
a corps of medical men as well educated, as efficient in the 
treatment of disease, and as practical in public hygiene as 
their European and American confreres. During thou- 
sands of years China has suffered severely from the 
blighting tyranny of superstition, priestcraft and selfish 
bureaucracy, and, now that the sunlight of truth and 
genuine liberty is beginning to search every nook and 
cranny of that great country, we who have had the advan- 
tage of this beneficent influence for so many scores of years 
truly rejoice over the change that is taking place in China. 



CHAPTER IV 

GREEK MEDICINE AT THE DAWN OF HISTORY 

It is from Greece and from Greece alone, says Darem- 
berg, that our modern medicine derives its origin. 

It has come down to us, in a direct line, through the sheer force 
of its inherent excellence, and with little or no aid from outside 
sources. Harvey, Bichat and Broussais are as much the legitimate 
heirs of Hippocrates, Herophilus, Galen, Berenger de Carpi and 
Vesalius, as Hippocrates is the heir of Homer, and as this divine 
singer of the anger of Achilles is himself the product of a civiliza- 
tion that existed before his day and that was in all probability the 
creation of Hindu influences. 

It is to the development of medical knowledge in Greece, 
therefore, that our attention should next be directed, and 
more particularly to that period which belongs to the dawn 
of history — the pre-Homeric period. 

The pre-Homeric Period of Medicine in Greece. — The 
poems of Homer, the Iliad and the Odyssey, furnish us 
with the earliest and almost the only written evidence of 
the state of medicine in Greece during that period of time. 
They were probably written, according to the authority 
of the Earl of Derby, somewhere about 800 B. C, and 
modern investigations show that the siege of Troy, the 
theme of the Iliad, occurred between the years 1194 and 
1184 B. C. These investigations also show that in this 
region, and especially in the Island of Crete and in Mycenae 
on the neighboring mainland of Asia Minor, at this time 
and probably several hundred years earlier, there existed 
a high degree of civilization. Specimens of a written 
language, for example, were found among the objects 
recovered from the ruins of the palace of King Minos at 



GREEK MEDICINE 47 

Cnossus in Crete, but hitherto no interpreter of this 
unknown language has been found. It is reasonable to 
expect, however, that in due time these Minoan records 
will be translated, that still other records belonging to this 
remote age will be discovered, and that much valuable 
information regarding the condition of medical knowledge 
in Greece during this long period will then be revealed to 
us. Strange as it may appear, the classical Greek writers 
seem to have possessed very little knowledge concerning 
this highly developed civilization at Cnossus. And yet, if 
we stop to consider the matter, their silence will appear 
less strange for the following reasons. Some great 
calamity (war, an earthquake, or a conflagration) must 
have destroyed many of the evidences of Minoan civiliza- 
tion besides those which are now being brought to light; 
then, also, several hundred years elapsed between the 
occurrence of this disaster and the classical period of 
Greek culture ; and, finally, there is the fact that the knowl- 
edge of past historical events, when kept alive simply by 
tradition, slowly vanishes, until finally it becomes so vague 
as to possess very little value. The discoveries made in 
the Island of Crete and at Mycenae were not known to 
Daremberg when he wrote the lines quoted above, but he 
felt perfectly sure, from his knowledge of the laws of 
development in general, that a product so highly cultured 
as Homer could not have suddenly sprung into existence 
out of the apparent darkness and ignorance of the centuries 
immediately preceding his time. 

The State of Medical Knowledge at the Time of the Siege 
of Troy. — It is from Homer's Iliad and Odyssey that our 
authoritative knowledge of the most ancient Greek medicine 
is derived. In the former work mention is made of 
Aesculapius and his two sons, Machaon and Podalirius, 
both of whom accompanied Agamemnon and the Greek 
host in their expedition against Troy. According to this 
author's account they served in the double capacity of 
surgeons to the army and valiant leaders of troops. In 
order that the reader may judge for himself just what is 
the nature of the evidence furnished by Homer with regard 



48 GROWTH OF MEDICINE 

to the medical knowledge of that period, it seems desirable 
to introduce here a few of the more characteristic refer- 
ences which the poet makes to spear, javelin and arrow 
wounds, to the injuries caused by fragments of rocks 
hurled by the assailants, and to various remedial measures, 
both surgical and medical, employed for the relief of the 
wounded or sick warriors. There are at least one hundred 
such passages in the Iliad alone, but the few which are here 
cited will serve as adequate examples of Homer's famil- 
iarity with anatomy and with some of the methods of 
treating spear and arrow wounds, — a familiarity which 
indicates that the poet must have had some medical training. 

Thus he ; and not unmoved Machaon heard : 

They through the crowd, and through the wide-spread host, 

Together took their way ; but when they came 

Where fair-hair 'd Menelaiis, wounded, stood, 

Around him in a ring the best of Greece, 

And in the midst the godlike chief himself, 

From the close-fitting belt the shaft he drew, 

With sharp return of pain ; the sparkling belt 

He loosen 'd, and the doublet underneath, 

And coat of mail, the work of Arm 'rer 's hand. 

But when the wound appeared in sight, where struck 

The stinging arrow, from the clotted blood 

He cleans 'd it, and applied with skilful hand 

The healing ointments, which, in friendly guise. 

The learned Chiron to his father gave. 

(Book lY. of the Iliad, Lines 221-259.) 



He said : the spear, by Pallas guided, struck 

Beside the nostril, underneath the eye ; 

Crashed through the teeth, and cutting through the tongue 

Beneath the angle of the jaw came forth : 

Down from the car he fell ; and loudly rang 

His glittering arms : aside the startled steeds 

Sprang devious : from his limbs the spirit fled. 

Down leaped Aeneas, spear and shield in hand. 

Against the Greeks to guard the valiant dead; 

And like a lion, fearless in his strength, 



GREEK MEDICINE 49 

Around the corpse he stalk 'd, this way and that, 

His spear and buckler round before him held, 

To all who dar 'd approach him threatening death, 

"With fearful shouts ; a rocky fragment then 

Tydides lifted up, a mighty mass, 

"Which scarce two men could raise, as men are now : 

But he, unaided, lifted it with ease. 

With this he smote Aeneas near the groin, 

"Where the thigh bone, inserted in the hip. 

Turns in the socket joint ; the rugged mass 

The socket crushed, and both the tendons broke. 

And tore away the flesh : down on his knees, 

Yet resting on his hand, the hero fell ; 

And o'er his eyes the shades of darkness spread. 

(The Iliad, Book V., Lines 333-356.) 



He said, and passing his supporting hand 

Beneath his [Eurypylus'] breast, the wounded warrior led 

"Within the tent ; th ' attendant saw, and spread 

The ox-hide couch ; then as he lay reclined, 

Patroclus, with his dagger, from the thigh 

Cut out the biting shaft ; and from the wound 

"With tepid water cleans 'd the clotted blood ; 

Then, pounded in his hands, a root applied 

Astringent, anodyne, which all his pain 

Allayed; the wound was dried, and stanch 'd the blood. 

(The Iliad, Book XI., Lines 958-967.) 
• #****«#« 

But Jove-born Helen otherwise, meantime. 

Employed, into the wine of which they drank 

A drug infused, antidote to the pains 

Of grief and anger, a most potent charm 

For ills of every name.^ "Whoe 'er his wine 

So medicated drinks, he shall not pour 

All day the tears down his wan cheeks, although 

His father and his mother both were dead, 

Nor even though his brother or his son 

Had fallen in battle, and before his eyes. 

(Book IV. of the Odyssey, Lines 275-284.) 
1 Nepenthes, believed to be opium, is the word employed in the original. 



50 GROWTH OF MEDICINE 

In former years and down almost to the present time, 
it was the custom among English medical writers to speak 
of Aesculapius only as the ''God of Medicine," thus con- 
veying to the minds of many readers that he was a 
mythological character, not a real personage. To-day, and 
especially since Schliemann has demonstrated, by his 
excavations at the site of ancient Troy, that Homer's 
Iliad is not merely a beautiful creation of his poetic fancy, 
but a narration of events that actually occurred about 1200 
B. C, it is quite generally acknowledged that Aesculapius^ 
is an historical character, an individual whose memory 
should receive due honor from the physicians of modern 
times. Neither Homer nor Pindar speaks of him as a god. 
In Athens he was publicly deified in 420 B. C. 

When Daremberg, as quoted above, expressed the belief 
that Hippocrates was the product of an earlier civilization, 
he undoubtedly gave due weight to other circumstances 
beside those which are narrated in Homer's poems — 
circumstances, for example, which are referred to casually 
by several of the classical Greek authors, and to which 
fresh importance has been given by a number of recent 
discoveries. Thus, there is an abundance of evidence 
showing that the Greeks, both before and after Homer's 
time, held the memory of Aesculapius in the very highest 
honor. So great, as they believed, was his power over 
disease, so wonderful were the cures which he accomplished, 
and so noble and pure was his character, that they made 
him a god and erected temples in his honor — not mere 
places where a barren worship might be carried on, but 
veritable sanatoria — termed Asclepieia — where the extraor- 
dinary healing powers of him whom they had made a 
god might be perpetuated for the benefit of succeeding 

2 Aesculapius was held to be the son of Apollo, the god of medicine, and to 
have been instructed in the art of healing by Chiron, one of the centaurs. 
Beside his famous sons, Machaon and Podalirius, he had four daughters whose 
names — Hjgieia, Jaso, Panakeia and Aigle — have come down to us through 
the ages. His wife's name was Epione, and those of his two younger sons 
were Telesphorus and Janiscus, but all three of these names are rarely men- 
tioned by the Greek writers. 



GREEK MEDICINE 51 

generations. While, on the one hand, the ancient Greeks 
may have been full of superstitious beliefs, they were at 
the same time as kindly disposed toward their fellow men, 
as generous in their spending of money for this purpose, 
and as practical in their selection of suitable methods as 
are the benefactors of to-day all over the world. In course 
of time these so-called temples became the prototypes of 
our hospitals, sanatoria and schools of medicine, and it 
therefore seems only proper that they should here be 
described somewhat in detail. 

The so-called Aesculapian Temples and their Chief 
Purpose. — The first of these temples, or Asclepieia, were 
established at Trikka, in Thessaly ; at Cnidus, on the coast 
of Caria in Asia Minor, opposite Cos; at Epidaurus, in 
Argolis, Greece ; at Gyrene on the northern coast of Lybia, 
Africa, opposite the Island of Crete; at Crotona, on the 
southeastern coast of Italy; and, finally, at Athens. It is 
said that traces of as many as eighty of these Asclepieia 
have been found in different parts of the ancient world. 
One of them, for example, is known to have existed on the 
small island (Isola San Bartolommeo) in the Tiber, at 
Rome. Their management was intrusted, in the earlier 
years of their existence, to men who were descendants of 
Aesculapius — i.e., the sons and grandsons of Machaon and 
Podalirius. They were both priests and physicians, and 
are mentioned in history as the Asclepiadae. With the 
progress of time it became necessary, as one may readily 
understand, to intrust the temple service to individuals 
who were not members of the family of Aesculapius. The 
original Asclepiadae guarded as valuable secrets the 
methods of treatment and the pharmaceutic formulae 
which had been handed down to them by the head of the 
family. It was therefore natural, when these newly 
adopted members were installed in office, that they should 
be made to promise, under oath, not to *' divulge these 
secrets to any but their own sons, the sons of their 
teachers, or the pupils who were preparing themselves to 
become regular physicians." (Neuburger.) 

The divulging of these secrets, it may be assumed, 



52 GROWTH OF MEDICINE 

would gradually entail upon the organization of priest- 
physicians a serious money loss. As will be seen further 
on, the oath known as *'the Hippocratic Oath" omits these 
mercenary features, and thus places the vocation of 
physician upon a much higher level. 

It is an interesting fact, as noted by Hollaender, of 
Berlin, that Homer does not make the slightest mention 
of temples dedicated to Aesculapius; from which circum- 
stance it may be inferred that a long time — perhaps several 
hundred years — elapsed, after his death, before his country- 
men realized fully his greatness and the value of the 
services which he had rendered in his role of physician. 
Of the temples which were then built in his honor, all have 
long since fallen into ruins, but in recent years excavations 
have been made at some of the more important of these 
sites and under the guidance of competent scholars, and 
as a result our knowledge of the state of medicine in 
Greece between the time of Homer and the appearance of 
the Hippocratic writings has been greatly enlarged. The 
facts revealed by these excavations and the staternents 
which are to be found in classical Greek literature, but 
which previously did not receive all the consideration that 
they deserved, have now been pieced together and we have 
thus been furnished with a fairly satisfactory picture of 
the relations of the different chambers and spaces in these 
temples, and with a more or less complete account of the 
manner in which affairs were conducted by those in charge. 
The following short description which is based on the 
account recently published by Professor Meyer-Steineg of 
Jena, Germany, will put the reader in possession of all the 
more important facts.* 

There were two principal types of Asclepieia — one, like 
that of Epidaurus, in Argolis, which occupied an inland 
situation, that had clearly been chosen from religious 
motives alone, viz., because it was believed, in accordance 
with an ancient tradition, that at this spot Aesculapius had 

3 ' ' Kranken-Anstalten im grieehisch-romischen Altertum, ' ' von Dr. med. et 
jur. Theodor Meyer-Steineg, a. o. Professor an der Universitat Jena; Verlag 
von G. Fischer, 1912. 




FIG. 1. 



VIEW OF THE TEMPLE OF AESCULAPIUS 
ON THE ISLAND OF COS. 



As it must have appeared to the traveler, in the third century B. C, 
on his approach by sea to the port of that island. 

Reconstitution based upon recent photographs and upon surveys by 
Herzog {Koische Forschungen, 1904). 

(Courtesy of^Prof. Dr. Meyer-Steineg, of Jena, Gennany.) 



GREEK MEDICINE 53 

been born — and a second, like that of Cos, on the island of 
the same name in the Aegean Sea, which situation without 
doubt had been chosen chiefly because the locality was 
exceptionally healthful. Of the first of these two types 
of temples, the sites of both of which have been most 
carefully studied, very little need be said in this brief 
sketch. The purely medical aspects of this Asclepieion, 
to which at the height of its celebrity crowds flocked from 
all parts of Greece, are of minor interest. The temple and 
its accessory buildings, which appear to have been very 
extensive, were located in a narrow valley, not far distant 
from the seaside village which still to-day bears the name 
of Epidaurus. Then, also, the locality is deficient in one 
important respect — it has an insufficient supply of good 
drinking water; and, finally, it is only slightly elevated 
above the sea-level. Dr. Meyer-Steineg remarks that the 
patients who visited this temple must have owed whatever 
benefit they derived from the visit to other influences than 
those of a purely medical or hygienic character. Doubtless 
suggestion played an important part in any relief which 
they may have obtained, and the so-called temple-sleep was 
also doubtless a very effective factor in this direction. 
The Asclepieion at Cos, on the other hand, occupied a most 
healthful position on the northern slope of the ridge of 
mountains which extends throughout the entire length of 
the island and attains a maximum height of about 3000 
feet. (See Fig. 1.) 

It now remains for me to describe, as best I may within 
the limited space which is at my command, the results of 
the excavations and surveys that have been made in recent 
years on the Island of Cos. Professor Meyer-Steineg 's 
article on this subject* is the source from which I have 
derived the information contained in the following account. 

The temple and its associated buildings stood at an 
elevation of three hundred feet above the sea-level and at 
a distance of a little more than two miles from the city 
of Cos. The heights behind the temple were in former 

* ' ' Kranken-Anstalten im griechisch-romischen Altertum, * ' in Jenaer 
medisin.-historische Beitrdge, Jena, 1912. 



54 GROWTH OF MEDICINE 

times covered with forests and afforded ample protection 
against the debilitating and much-dreaded south wind. 
A brook of considerable size and of very pure water passed 
through the temple grounds; the spring (Burinna) from 
which it took its origin being located about 300 feet higher 
up on the side of the mountain. Not far off, in the same 
neighborhood, is a mineral spring, the water from which 
contains both iron and sulphur. All the physical conditions 
of this site were, therefore, very favorable to the restora- 
tion of both mental and bodily health. Professor Meyer- 
Steineg declares that it is scarcely possible to determine 
accurately the age of the Cos Asclepieion, — i.e., of the 
structures which the present ruins represent, — but he 
believes that some of them date no farther back than the 
third century B. C, at which time extensive structural 
alterations were made.® Then, at a still later date (first 
century A. D.), in consequence of the damage done by an 
earthquake, C. Stertinius Xenophon (at the instigation of 
the Roman Emperor Claudius, whose private physician 
he was) carried out some very radical changes. Not only 
were the separate buildings well supplied with running 
water, but even many of the individual rooms (of which 
there were a large number) were equipped mth the same 
conveniences. Hydropathy evidently formed an important 
part of the treatment in the reconstructed temple. (See 
Fig. 2.) 

As has been shown above, the climate, the freedom from 
disturbing factors of all kinds, the existence at that spot 
of a plentiful supply of pure water, the character of the 
structures composing the temple group, and the wide- 
spread belief among the people that the Asclepiadae were 
able, with the assistance of the god Aesculapius, to effect 
cures which were obtainable nowhere else — all contributed 
to make the temple at Cos one of the greatest sanatoria of 
ancient times. 

The buildings which constituted what is commonly 
termed the ''Temple of Aesculapius" at Cos were located 
on three artificially prepared terraces. The principal 

6 All important traces of the earlier structures seem to have disappeared. 



rv 




FIG. 2. BIRD'S-EYE VIEW OF THE TEMPLE OF AESCU- 
LAPIUS AND ASSOCIATED BUILDINGS ON THE 
ISLAND OF COS. 

As they appeared in the third century B. C. 

(Copied by permission from a model made by Prof. Dr. Meyer- 
Steineg for the Medico-historical Museum of the University of Jena, 
Germany.) 



GREEK MEDICINE 



55 



entrance to the group, as the excavations conducted quite 
recently by Herzog show, was on the lower terrace, and 
faced north — that is, toward the sea. From this lower 
level a broad staircase led to the second or intermediate 
terrace, which, in turn, was connected with the upper one 
by means of a very broad and massive series of steps. The 
southern limit of this upper terrace ended abruptly at the 
slope of the mountain. The arrangement of the buildings 











M 

jllllii'ii' ^ 



^,m,«iiiiim«\imwt«i«iii«» 




Ha fs St at) 



W i 8 B 38 •« ia ic ^ ' ti 1i toon 



PIG. 3. GROUND PLAN OP THE ASCLEPIEION ON THE ISLAND OP COS. 
As Ascertained by the Researches of Dr. Herzogr. 

The different structures are arrangred as nearly as possible in the same positions which 
they occupied in the third century, B. C. 

A, main entrance to Asclepieion; B, B, B, gallery, 6 metres broad, with colonnade on one 
side; C. open space or court, on the southern side of which is a structure composed of 
recesses provided each with a bathing basin (/?)/ H, staircase leading to intermediate terrace; 
a, massive series of steps leading to the upper terrace; *, b, b, broad gallery similar to that 
shown on the lower terrace; rf, the temple proper. 

(From Prof. Dr. Meyer-Steineg's Medizinisch-historiiche Beitrage.) 



56 GROWTH OF MEDICINE 

on the three different terraces may, in harmony with the 
account given by Professor Meyer-Steineg, be briefly 
described as follows: That which stood on the lower 
terrace occupied three sides of a parallelogram (Fig. 3), 
the open part of which faced south. The longer side of 
the building measured about 120 metres (390 feet) in 
length, and the two shorter sides each 55 metres (180 feet). 
The supply of running water in every part of this great 
building, which appears to have been devoted mainly, if 
not entirely, to therapeutic purposes, must have been most 
abundant. The source from which the water came was the 
Burinna spring, situated higher up on the mountain at a 
spot far beyond all possibility of contamination. It is not 
yet clear, says Dr. Meyer-Steineg, whether or not there 
were any buildings devoted to therapeutic purposes on the 
intermediate terrace. (Figs. 2 and 3.) On the other hand, 
the great halls, contained in the large building which 
surrounded the temple on the upper terrace, appear to 
correspond very closely to the rooms that constituted the 
main portion of the building on the lower terrace, and it 
is therefore probable that this upper building also served 
some useful purpose in the general scheme of the Ascle- 
pieion. It is Herzog's opinion — according to Meyer- 
Steineg — that the central idea around which everything 
in this assemblage of fine buildings revolved, was a clinic 
conducted by the Asclepiadae. The means chiefly employed 
at first for the restoration of health were such simple 
agents as sunlight, pure air, pure drinking water, dietetic 
measures, massage, physical exercise, etc., and yet, when 
the patient's condition seemed to require their use, there 
was no hesitation in resorting to the rational employment 
of drugs, and even surgical operations were performed. 
The numerous instruments which Dr. Meyer-Steineg col- 
lected at the site of the ruins when he visited Cos in 1910, 
furnish ample corroborative evidence of the correctness 
of this last statement. 

Not the least important part which this famous Ascle- 
pieion played in the history of medicine was the splendid 
opportunity which it afforded to those who were preparing 



GREEK MEDICINE 57 

themselves to engage in the practice of the healing art, for 
acquiring the necessary familiarity with the different 
diseases and for learning how they should be treated. 

The manner of conducting the preliminary treatment was 
probably not the same in every particular in all the different 
Asclepieia, and yet in the main the plan of procedure 
followed in Epidaurus, in Cos and in Athens undoubtedly 
resembled closely that which Pagel furnishes in his 
Geschichte der Medizin. It may be briefly described as 
follows : — 

In the first place, moribund persons, the unclean, and 
women about to be confined were not admitted into the 
temple enclosure. The management of the latter class of 
patients was left entirely to women nurses, and, when it 
became evident that a person was likely to die, the indi- 
vidual was thereafter cared for outside the enclosure.® In 
short, everything possible was done to keep out of sight 
all such objects as might produce an unpleasant impression 
upon applicants for treatment. After preliminary bathing 
and dieting, the patient was conducted into the temple 
enclosure and encouraged to make offerings and to pray 
to the god Aesculapius, an imposing statue of whom in 
marble was one of the first things that confronted him. 
As he was led about by the priest or an attendant, his 
imagination was wrought upon by the sight of numerous 
votive offerings exposed to view on the walls or columns 
of the buildings, by the singing of hymns in adoration of 
the god, and by the reading of the records of earlier cases 
inscribed on tablets or on the columns. After his mind had 
thus been worked upon, he was asked to furnish to the 
priest a detailed history of his own case and to submit to 
some sort of physical examination. As a final and most 
important step in this first stage of the treatment he was 
subjected to what was termed ''the temple-sleep," during 
which the suggestion of the proper remedies to be employed 
was supposed to be communicated to him by the god himself. 

« The Emperor Antoninus Pius, in order to provide properly for these 
patients, erected at Epidaurus a special building in which confinement cases 
and those likely to end fatally might be lodged. 



58 GROWTH OF MEDICINE 

In our day it is difficult to understand how persons of 
a fair degree of intelligence could for so long a period have 
continued to believe in the efficacious interference of the 
deified Aesculapius in their behalf. But that this belief 
really did exist is well known, and it was only after the 
lapse of many centuries that the faith of the public began 
to weaken, doubtless through the influence of several 
factors. Perhaps the most important of these was the 
discovery of an increasing number of instances of hum- 
buggery or trickery, of which the officiating priests, in some 
of the temples, had been guilty. The satirical writer, 
Aristophanes, who flourished in Athens about 400 B. C, 
describes an incident of this nature in his play entitled 
*'Ploutos." The following extracts furnish an account of 
the doings observed by the slave Karion on the occasion 
of his passing a night in the temple enclosure at Athens : — 

The Scene throughout is laid at Athens, in front of the 
house of Chremulos. 



Blepsidemos : Ought n't we then to bring in some doctor? 

Chremulos: Prythee, what doctor is there now in the city? 
For their pay is no longer anything worth, nor their art. 

Blep. : Let us cast about. 

Chrem.: Nay, there is not one. 

Blep. : I believe there is not. 

Chrem.: Nay, by Zeus, the best plan is to do what I have been 
long preparing — (to conduct him [Ploutos] ) to the temple of 
Asklepios [and] make him lie down [there]. 

Chrem.: Karion, my man, you must bring out the bed-clothes 
and lead Ploutos himself in the usual way, and carry everything 
else that is ready within. 

{Exeunt omnes.) 



Chorus of Farthers. What is the matter. Oh thou best friend 
of — thyself? For you seem to have come as a messenger of some 
good news. 



GREEK MEDICINE 59 

Karion!' My master has fared most prosperously, or rather 
Ploutos himself. For, instead of being a blind man, he has been 
made to see again, and his pupils are clear-sighted, as he has met 
with a kindly friend in Asklepios the Healer. 

Chorus. You give me reason for joy, reason for shouts of 
triumph. 

Karion. Ye have reason to rejoice whether ye wish it or not. 

Chorus. I will shout aloud for Asklepios of the goodly children, 
the great light to mortals. 

• *•••••••• 

Karion. Well, as soon as ever we came to the god, leading a 
man then, indeed, most miserable, but now blessed and fortunate, 
if any other is so, first we led him to the sea, and then we bathed 
him. 

Wife of Chremulos. By Zeus, then the old man was fortunate, 
bathing in the cold sea. 

Karion. Then we went to the sacred enclosure of the god. And 
when on the altar the cakes and offerings were dedicated by the 
flame of murky Hephaistos, we laid down Ploutos, as was proper; 
and each of us made up from little odds and ends a bed for himself. 

Wife. Then were there certain others beside yourselves wanting 
the god ? 

Karion. Yes, Neokleides, for one, and he is blind; but in 
stealing has far overshot those who can see ; and there were many 
others with all sorts of ailments. But when the minister of the 
deity put out the lights and told us to go to sleep and said that we 
were to keep silent, if any of us perceived a noise, we all lay down 
in an orderly manner. And I was unable to sleep, for my attention 
was arrested by a certain pitcher of porridge a little way off from 
the head of a certain old woman, and, I strangely desired to creep 
over to that pitcher. Then I looked up and saw the priest making 
a clean sweep of the cakes and dried figs from the sacred table. 
After this he went round all the altars in a circle to see if any 
cakes were left anywhere. Then he consecrated them into a certain 
wallet; and I, believing that there was great holiness in this 
proceeding, rise up to go to the pitcher of porridge. 

Wife. Oh you most miserable of men, were you not afraid of 
the god? 

Karion. Yes; by the gods I was afraid lest he with his fillets 
should reach the pitcher before me; for the priest had already 

' The slave of Chremulos. 



60 GROWTH OF MEDICINE 

given me a lesson. But, as soon as ever the old woman perceived 
the noise I made, she lifted up her hand over the pitcher (to protect 
it). Then I hissed and seized (her hand) by the teeth as if I were 
a reddish-brown snake. But she at once drew back her hand again 
and lay down peacefully, rolling herself up. And then I at once 
gulped down a lot of the porridge; and then, when I was fuU, I 
jumped up again. 

Wife. And didn't the god come up to you? 

Karion. Not up to that time. After this I at once covered 
myself up, being afraid ; but he made a complete circuit examining 
all the ailments in a most orderly fashion ; and then a slave set by 
him a little mortar and box of stone. 

Wife. Of stone ? 

Karion. No, by Zeus, certainly not, — at least, not the box. 

Wife. To the deuce with you, how did you see since you say 
you were covered up ? 

Karion. Through my old cloak; for, by Zeus, it had holes not 
a few. First of all, he took in hand to pound a plaster for Neo- 
kleides, and he threw in three cloves of Tenian garlic. Then he 
bruised them in the mortar, mixing therewith the acid juice of the 
fig-tree and squill ; then, having diluted it with Sphettian vinegar, 
he turned his eyelids inside out that he might feel more pain, and 
then applied the mixture. But he, squalling and bawling, jumped 
up and was running away, when the god said with a laugh : — * ' Sit 
down there now, smeared with thy plaster, that I may stop thee 
from going to the Assembly, having for once a real excuse. ' ' 

Wife. What a patriot and sage the god is ! 

Karion. After that he sat down by the side of Ploutos, and 
first he touched his head, and then, taking a clean towel, he wiped 
his eyelids all round, and Panakeia covered his head and all his face 
with a cloth of purple dye ; and the god then whistled. Thereupon 
two snakes of monstrous size darted forth from the temple. 

Wife. Dear Gods ! 

Karion. And these two (snakes) having quietly glided under 
the crimson cloth, licked his eyelids all around, methought. And 
before you could drink ten cups of wine, my mistress, Ploutos 
stood up and was able to see : and I clapped my hands with delight 
and awoke my master. And the god suddenly took himself off 
from our view with the snakes into the temple. 

If one examines carefully the facts connected with the 
Aesculapian temple treatment, so far as they are known 



GREEK MEDICINE 61 

to us, one cannot fail to be impressed with their strong 
resemblance to what has been the experience of similar 
semi-religious movements in more recent times, not only 
in European countries but also in the United States. In 
all of them there may be found a kernel of true religious 
belief, and no candid observer can deny the fact that many 
persons have been benefited thereby both in body and in 
mind. But, sooner or later, the method has fallen into 
disrepute, either because it was employed in the vain hope 
that it might accomplish a cure which surgical means alone 
could effect, or else because unscrupulous persons, taking 
advantage of the credulousness of those associated with 
the movement, utilized it for their own selfish advantage. 



CHAPTER V 

THE SIGNIFICANCE OF THE SERPENT IN THE 
STATUES AND VOTIVE OFFERINGS EXPOSED 
TO VIEW IN THE AESCULAPIAN TEMPLES 

Almost every important gallery of sculpture in Europe 
possesses at least one marble statue of Aesculapius, and in 
the majority of these the god is represented as a middle- 
aged or elderly man of powerful frame, having a full head 
of hair and full beard, and clothed only with the pallium 
or mantle, which is so placed as to leave the right shoulder 
and a large part of the chest uncovered. He holds in his 
right hand a knotted staff around which, in many of the 
statues, is coiled a serpent whose head approaches very 
closely to the hand. The expression of the god's counte- 
nance is strikingly peaceful and serene, yet without any 
evidence of weakness. In not a few instances other animals 
are represented alongside the statue, usually at the god's 
feet — as, for example, the cook, the owl, the eagle, the hawk 
or the ram — and occasionally his daughter Hygieia is 
shown at his side feeding the serpent. The cock is the 
symbol of watchfulness — a physician should be vigilant; 
the owl symbolizes his need of clearsightedness and of 
readiness to care for his patients in the night as well as 
during the day; the eagle has a penetrating eye and it is 
the emblem of long life — a benefit which the healing art is 
capable of procuring; the hawk was the bird consecrated 
to Isis, Queen of Egypt, who was believed by the Egyptians 
to have been highly skilled in medicine ; and the ram is the 
symbol of dreams and divination. Pliny says that the 
patients who were brought to the temple of Aesculapius 
were made to lie down at night wrapped in the skin of a 



'-V 




HEAD OF THE 

MARBLE 

STATUE OF 

THE GOD 

AESCULAPIUS 

IN THE 

NAPLES 

MUSEUM 



FIG. 4. ANCIENT STATUE OF THE 

GOD AESCULAPIUS IN THE 

BERLIN MUSEUM. 

(From Hollander'.s Plaslik und Medizin, with 
the author's permission.) 



SIGNIFICANCE OF THE SERPENT 63 

ram, in order that they might have divine dreams. The 
presence of the serpent in nearly all of the statues of 
Aesculapius is explained in a variety of ways. Some say 
that this reptile, which sheds his skin once a year, is 
emblematic of the sick person 's need to acquire a new body, 
or at least cast off his old skin in the same manner as does 
the snake. Others consider the serpent as merely the 
symbol of wisdom, as it is admittedly the shrewdest and 
most cunning of all animals. In a few instances it is 
represented as drinking from a receptacle held in the hand 
of Hygieia. Perhaps the sculptor's intention here was to 
show that the serpent, although the wisest of all animals, 
believed that he might add to his stock of wisdom by 
drinking from the fountain under the control of Aescula- 
pius, thus conveying the impression that the wisdom of the 
latter was greater than his own. But all these interpre- 
tations are too subtle for the uneducated mind to appre- 
ciate at a glance. They fail also to satisfy our preconceived 
ideas of what such a statue should be — viz., a memorial of 
the godlike character of Aesculapius and of the priceless 
benefits which he conferred upon his fellow men, and, at 
the same time, an object which, when first contemplated 
by one who is ill, would at once evoke in that person feelings 
of perfect confidence in the ability and the willingness of 
the god represented by the statue to effect a cure. Some, 
perhaps even a majority, of the statues thus far recovered 
from the ruins of the different Aesculapian temples cer- 
tainly fail to arouse any such sentiments in the minds of 
ordinary observers ; but there are others which do in some 
measure accomplish this, and among the number the statue 
which may be seen in the Berlin Museum ancj of which a 
photographic copy (Fig. 4) is here reproduced, should 
certainly be included. The head of the god is less imposing 
and the expression less kindly than are these features in 
some of the other statues (see, for example. Fig. 5), but, 
to offset this, the serpent represented in the latter is of 
the non-poisonous variety.^ The addition of such a harm- 
less creature to the figure representing the god contributes 

1 To save space the head of the god alone has been reproduced in Fig, 5. 



64 GROWTH OF MEDICINE 

nothing to the power of the statue as a whole to impress 
the people — i.e., the uneducated masses, as, for example, 
the peasants, etc. On the other hand, the significance of 
the poisonous snake in a statue of this character will be 
readily appreciated if one considers the fact that in ancient 
times, as it is even to-day in India, the loss of life caused 
by the bites of poisonous snakes was enormous. In the 
presence of such a fact, therefore, it would be difficult for 
a sculptor who was desirous of emphasizing the extraor- 
dinary healing powers of his hero to accomplish this more 
effectively than by embodying in his statue, along with 
other impressive features, such characters as would show 
him to have gained the mastery over that terribly fatal 
malady — the bite of the viper and of the still more deadly 
serpents of India and parts of Africa. Although we 
possess no facts which would warrant the statement that 
Aesculapius had been particularly successful in the treat- 
ment of this form of poisoning, these temple statues furnish 
indirect proof of a strong character that his healing power 
in this direction had been very great, — so great, indeed, 
as to have been largely instrumental in winning for him 
the appellation of a god. Such a striking object, especially 
when its more important features were commented upon 
by the priest who accompanied the patient on his or her 
first tour of inspection of temple wonders, could scarcely 
have failed to produce a very deep impression upon the 
imagination. 

In the illustration which has here been reproduced 
(Fig. 4), a viper, as clearly shown by the shape of his head 
and neck and by the unusual length of the jaw, has twined 
himself about the staff and is close to the god's hand, so 
close that in an instant's time the fatal bite might readily 
be inflicted. But Aesculapius shows by his countenance, by 
the unconcerned manner in which he allows his right hand 
to remain near the serpent's head, and by the easy pose 
of his whole body, that he is not at all concerned about the 
danger which appears to threaten his life. In the estima- 
tion of the ancient Greeks this fearlessness was undoubt- 
edly attributed to the supernatural power which they 



SIGNIFICANCE OF THE SERPENT 65 

believed Aesculapius to possess over dangerous serpents 
as well as over diseases of all kinds. 

So far as now appears, all the statues of the god that 
have been dug up in Greece or its nearest colonies represent 
the serpent as of the size commonly observed in that part 
of the world. HoUaender, however, furnishes (on page 118 
of his work) an illustration which represents — as Ije 
believes — the god Aesculapius in the presence of an 
enormous snake, evidently a python. ( Fig. Q.) yAs this 
variety of serpent is not to be found in Greece, or indeed 
at any point further north than the Mediterranean coast 
of Africa, it is fair to assume that the bas-relief which 
depicts this scene must have been made for exhibition in 
an Asclepieion located at Cyrene or at the relatively near 
city of Alexandria, where patients, who were more or less 
familiar with this serpent and realized its power of 
crushing people to death, would have occasion to witness 
this suggestive work of art. And, furthermore, as if it were 
for the express purpose of emphasizing the great protective 
power of the god, the sculptor has introduced, on one side 
of the scene, the figures of three women, two young children 
and a lamb. The women nearest to the monster have 
folded their arms and do not manifest the least sign of fear. 
The children also appear to be unaware of the presence 
of a deadly danger. In short, the proximity of the god 
Aesculapius has instilled into the minds of these human 
beings the most complete sense of fearlessness ; he himself, 
as in the case of the statue of Aesculapius shown in Fig. 4, 
exhibiting a complete absence of fear in the presence of 
the dangerous monster. Neither death by poisoning nor 
death by constriction has any terrors for him to whom 
the patient is about to appeal for relief from disease. 

That pythons were a terror in former times to the people 
who inhabited the coast regions near Cyrene is evident 
from a statement which Aristotle makes in his History 
of Animals (Book VIII., Chapter xxviii.). It reads as 
follows : — 

In Libya (Africa) the serpents, as has been already remarked, 
are very large. For some persons say that, as they sailed along 



66 GROWTH OF MEDICINE 

the coast, they saw the bones of many oxen, and that it was evident 
to them that they had been devoured by the serpents. And, as 
the ships passed on, the serpents attacked the triremes, and some 
of them threw themselves upon one of the triremes and overturned 
it. 



CHAPTER VI 

THE BEGINNINGS OF A RATIONAL SYSTEM OF 
MEDICINE IN GREECE 

With the lapse of time the religious and mystical features 
of the treatment carried on at the Asclepieia gave place, 
more and more, to rational methods, and eventually — it 
is scarcely possible to mention a date, but probably not 
many years before the Hippocratic period — these institu- 
tions became centres for the spread of medical knowledge 
of the most practical kind. This is particularly true of the 
Asclepieion at Cos, where Hippocrates is believed to have 
received his medical training. It is interesting to note that 
the ijaystical features of the temple treatment — features 
which certainly did not originate with Aesculapius himself 
or with his sons, Machaon and Podalirius — eventually 
proved powerless to stay the slow but sure advance of 
sound medical knowledge. Even during the period when 
these false elements seemed to be most strongly rooted 
in the temple methods, there were forces at work which 
in due time deprived them of much of their pernicious 
power. This result was inevitable, for an organization 
which, in order to prosper in its work of doing good to 
humanity, depended upon the natural superstitiousness of 
the people, could not possibly thrive for an indefinite 
length of time. That the evil results did not develop sooner 
than they did simply shows how powerful and stubborn is 
the force of superstition. In the absence of trustworthy 
historical evidence, hypothetical statements only can be 
brought forward, but there can scarcely be any doubt but 
that a genuine belief in the power of Aesculapius (deified) 
to cure disease and restore health persisted for centuries. 

The custom of recording the case histories on tablets or 



68 GROWTH OF MEDICINE 

on the colunms of the temple, — for at this period writing 
was in general use, — and also that of dedicating to the god 
images which represented (sometimes with a remarkable 
degree of truthfulness) the pathological condition for 
which the patient sought relief, contributed very greatly 
to the substitution of sound learning for religious mysticism 
and poorly concealed humbuggery. 

Among the interesting objects which may be seen at the 
Museum of the History of Medicine in Jena, Germany, 
there are several of these terra-cotta images (votive 
offerings) representing pathological conditions; and 
among them the writer noticed more particularly one 
which reproduced faithfully, though in diminutive size, the 
appearances presented by cancer of the female breast. 
(Fig. 7.) There were also a very carefully modeled 
statuette of the trunk of a woman affected with ascites, 
and an admirable representation of a case of facial 
paralysis. (Fig. 8.) These objects were obtained by 
Professor Meyer-Steineg on the occasion of a recent visit 
to the ruins of the temple of Cos and other similar ruins 
in Greece and Asia Minor. The British Museum possesses 
many objects of the same character. 

It is not known at what precise date the iatreia, or small 
private hospitals, first made their appearance, but it was 
about the time when the religious character of the thera- 
peutic work done in the Asclepieia gave place to treatment 
of a more distinctly medical character. Then, in addition 
to these iatreia, there were schools for gladiators and 
institutions in which gymnastic exercises were zealously 
cultivated ; and in these places there was a frequent demand 
for advice in regard to questions of diet, and for surgical 
aid in the setting of broken bones, the reducing of dis- 
locations, and the curing of bruises and sprains. As may 
readily be understood, the Asclepieia could not furnish the 
sort of professional aid which these institutions needed, 
and thus a further stimulus was given to the complete 
separation of the two kinds of medical practice — that 
connected with the temple and that conducted by outside 
physicians. 




jS£BC-"w»- 



I i(.. o. BAS-RELlKi- (;i- AESCULAPIUS. ACCOMPANIED BY WOMEN 

AND CHILDREN, IN THE PRESENCE OF AN 

ENORMOUS SERPENT. 

The original is in the National Museum at Athens. 




FIG. 7. FEMALE BUST SHOWING CANCER OF ONE BREAST. 
(Courtesy of Prof. Dr. Meyer-Steineg, of Jena, Germany.) 



BEGINNINGS OF A RATIONAL SYSTEM 69 

In Plato's ''Republic" (Book III., Chapter 15) mention 
is made of a certain Herodicus (of Selymbria; about 
450 B. C.) who effected many cures by a method of treat- 
ment which combined athletic exercises with dieting. He 
gained considerable celebrity in this way, and is undoubt- 
edly entitled to the credit of having been the first to call 
serious attention to the value of this plan of treating 
certain maladies. But, unfortunately, he made use of it 
in not a few instances where it proved harmful rather than 
beneficial to the patient, and thus brought discredit upon 
the method. 

Already previous to the time at which the changes 
mentioned above took place, there had occurred still other 
changes in the character and practice of medicine. The 
business of cutting for stone in the bladder, for example, 
had been left entirely in the hands of men who made a 
specialty of this branch of medicine — men who might 
truthfully be called medical artisans. Then there was 
another class of men who devoted their energies to col- 
lecting medicinal roots and plants. They were a necessity 
to physicians, and constituted the first representatives of 
the modern apothecary. Still another change in the status 
of the Greek physicians had been slowly developing 
throughout this pre-Hippocratic period, a change which 
tended more and more to make them men of self-reliance 
and of considerable importance in their respective com- 
munities, and which indicated very clearly that they were 
steadily growing in skill and breadth of knowledge. As 
evidence of the correctness of this statement it is sufficient 
to mention the fact that Greek physicians had established 
so good a reputation that they were frequently called to 
see important cases at a great distance — in Egypt, in 
Persia, etc. But before further consideration is given to 
this subject of the development of the Greek physician 
during the period immediately preceding the appearance 
of the Hippocratic writings, it seems advisable to say a 
few words concerning the facilities for medical instruction 
which were available at that time. 

Medical Instruction in Connection with the Asclepieia. — 



70 GROWTH OF MEDICINE 

It does not appear clearly in any of the published descrip- 
tions of these ancient Greek sanatoria just what were the 
relations between the priests and the men who utilized all 
this rich clinical material — records of all sorts of diseases, 
and the means (other than religious) employed in treating 
them, pictures or plastic reproductions of the visible 
pathological lesions, etc. — for the purpose of instructing 
the younger men who contemplated engaging in the 
practice of medicine. The modern teachers of the art know 
very well how difficult is the task of combining in a satis- 
factory manner these two things — the safeguarding of the 
patient's interests and the utilization of their maladies as 
object lessons for men who are preparing to cure or relieve 
the bodily ills of those who may at some future moment 
need their professional services. To them, therefore, it 
would be a matter of very great interest to learn how 
this difficult problem had been solved nearly twenty-five 
hundred years ago. But, unfortunately, no satisfactory 
data upon which a trustworthy account might be founded 
are obtainable, and we are obliged to fall back upon such 
aid as our imagination may furnish. From Puschmann's 
work on medical teaching in ancient times the following 
statement relating to the subject has been taken : — 

The priests in the Aesculapian temples were not, as is generally 
assumed, physicians in the ordinary sense. They may have 
acquired some knowledge of the art, and they may even in some 
instances have been regularly trained physicians, but the important 
fact remains that they wished it to be understood that the treatment 
carried out in the temple was in accordance with revelations made 
to them by the god Aesculapius, and not the mere fruit of human 
knowledge. Consequently the intervention of regular physicians 
in the temple management of the sick must have appeared to them 
quite superfluous. For this reason, therefore, it is not likely that 
there existed, on the part of either the temple priests or the 
physicians, any feeling of animosity or opposition. It is more 
likely that the contrary was the case, for the evidence shows that 
the physicians — the Asclepiadae — paid most humble reverence to 
the sacred relics of Aesculapius, and placed the most implicit 
confidence in the opinions which he was supposed to give in 
desperate cases. 



70 - 




FIG. 8. PARALYSIS OF THE LEFT 
FACIAL NERVE. 

(Courtesy of Prof. Dr. Meyer-Steinegr, Jenaer medi- 
zinisch-hislorische Beiirage, Heft 2, 1912.) 



BEGINNINGS OF A RATIONAL SYSTEM 71 

While Puschmann does not say to what period in the 
history of these temples his statement applies, it is safe 
to assume that he had in mind only the earlier stages. 
When the systematic teachings of medical pupils began, 
those physicians who gave the instruction — ^viz., the Ascle- 
piadae who were not at the same time priests — took up their 
abode somewhere in the neighborhood of the temple. Thus, 
medical schools were formed at different places, those of 
Rhodes, Crotone, Cyrene, Cos and Cnidus attaining the 
greatest celebrity. The pupil paid a fee for his instruction, 
and when his training was believed to be completed he was 
admitted into the association or brotherhood of the 
Asclepiadae upon taking the following oath, which for ages 
past has been known as **The Hippocratic Oath,'* but 
which is now believed to have been formulated long before 
the time of Hippocrates : — 

THE HIPPOCRATIC OATH 

I swear by Apollo the Physician and Aesculapius, and Hygieia 
and Panacea and all the gods and all the goddesses — and I make 
them my judges — that this mine oath and this my written engage- 
ment I will fulfil as far as power and discernment shall be mine. 

Him who taught me this art I will esteem even as I do my 
parents; he shall partake of my livelihood, and, if in want, shall 
share my goods. I will regard his issue as my brothers and will 
teach them this art without fee or written engagement if they shall 
wish to learn it. 

I will give instruction by precept, by discourse, and in all other 
ways, to my own sons, to those of him who taught me, to disciples 
bound by written engagements and sworn according to medical 
law, and to no other person. 

So far as power and discernment shall be mine, I will carry out 
regimen for the benefit of the sick and will keep them from harm 
and wrong. To none will I give a deadly drug even if solicited, 
nor offer counsel to such an end ; likewise to no woman will I give 
a destructive suppository; but guiltless and hallowed will I keep 
my life and mine art. I will cut no one whatever for the stone, 
but will give way to those who work at this practice. 

Into whatsoever houses I shall enter I will go for the benefit 
of the sick, holding aloof from all voluntary wrong and corruption, 
including venereal acts upon the bodies of females and males 



72 GROWTH OF MEDICINE 

whether free or slaves. Whatsoever in my practice or not in my 
practice I shall see or hear amid the lives of men which ought not 
to be noised abroad — as to this I will keep silence, holding such 
things unfitting to be spoken. 

And now if I shall fulfil this oath and break it not, may the 
fruits of life and of art be mine, may I be honored of all men for 
all time ; the opposite if I shall transgress and be forsworn. 

(Translated from the Greek by the late John G. Curtis, M.D., of 
New York.) 

While at first, according to Puschmann, many physicians 
did not belong to the Aesculapian Brotherhood, there came 
a time when all were known as Asclepiadae. 

Influence of the Schools of Philosophy on the Growth of 
Medical Knowledge. — About the beginning of the sixth 
century B. C. there developed, in Greece and its colonies, 
schools of philosophy which exerted a most excellent 
influence upon the growth of medicine. The first of these 
was the one known as the Ionian School, whose founders 
and chief representatives were Thales, of Miletus in Ionia 
(born in 640, died in 548 B. C), and his pupils Anaximander 
and Anaximenes. The guiding principle of these men was 
to study natural phenomena and to learn, if possible, their 
causes and the laws of their action. Physiology, therefore, 
became one of their special studies, and thus they con- 
tributed to the laying of one of the most important 
foundation-stones of medicine. Thanks to the good 
quality of the work of instruction that had thus far been 
carried on at Cos, Cnidus, and other Asclepieia, medicine 
had by this time reached a sufficient degree of development 
for its devotees to derive a full measure of benefit from 
the new teaching of the philosophers. Well grounded in 
the observation of disease in its different forms and modes 
of behavior, and also familiarized with the ordinary 
methods of treatment, these physicians needed to be shown 
a new route along which they might advance to greater 
heights of knowledge, and they also needed to be stimu- 
lated to further endeavor. The introduction of the new 
school accomplished both of these purposes. It taught the 
men of the older organizations that they must make much 



BEGINNINGS OF A RATIONAL SYSTEM 73 

greater use of their reasoning powers than they had 
hitherto done, and at the same time, through the creation 
of a group of rival physicians, it supplied them with the 
required stimulus. Another important school of philosophy 
was that known as the Eleatic School, which flourished at 
Elea, in Lower Italy, its leaders being natives of that city. 
The most prominent men connected with this school were 
Parmenides (born about 540 B. C.) and Xenophanes of 
Colophon, in Asia Minor, whose contributions to mental 
science formed the basis of Plato's metaphysics. 

The period roughly embraced between the years 500 and 
300 B. C. represents the most brilliant age of Greek 
intellectual and artistic activity. During this time there 
came into prominence such philosophers, historians, poets, 
physicians, artists and generals of armies as had never 
before been marshaled in historic array in so rapid 
succession. Even at this late day the names of these great 
men are almost household words — such names, for example, 
as Pythagoras, Alcmaeon, Anaxagoras, Aristotle, Plato, 
Socrates, Sophocles, Aeschylus, Euripides, Aristophanes, 
Pindar, Xenophon, Demosthenes, Democedes, Hippocrates 
the Great, Phidias, Praxiteles, Zeuxis, Apelles, Darius I., 
Alexander the Great, and many others of almost equal 
celebrity. During the centuries immediately preceding 
this golden age of Greek history, there seem to have 
been very few men of great merit in any of the branches of 
learning or in the fields of war or art, but this impression 
is certainly false. It is doubtless to be explained by the 
fact that large quantities of documentary evidence relating 
to these years have been entirely lost. Daniel Le Clerc, 
for instance, states^ that, of the separate histories of the 
descendants of Aesculapius which were written by Eratos- 
thenes, Pherecydes, ApoUodorus, Arius of Tarsus and 
Polyanthus of Cyrene, not one has come down to our 
time. If, then, in the single department of medicine, 
the destruction of documentary evidence was as great as 
is here represented, how enormous must have been the 
loss of precious historical materials in all the departments 

1 Histoire de la Medecine, Amsterdam, 1723. 



74 GROWTH OF MEDICINE 

of human activity taken together. We may, therefore, 
safely assume that this golden age, which lasted only about 
two hundred years, represents simply the culmination of 
an even longer period of slow but steady development, 
a period of creditable though perhaps less brilliant 
achievements. 

Of the names mentioned above there are several that 
belong to men who were in various ways connected with the 
early history of medicine. Pythagoras, for example, is 
said to have been one of the first among the Greek philoso- 
phers to exert a strong and double impression upon the 
medical teaching of that period. He was born in the Island 
of Samos, near the coast of Asia Minor, about the year 
575 B. C. After spending several years in Egypt for 
purposes of study, and probably visiting Babylon, at' that 
time a great centre of learning and of artistic cultivation, 
he established at Crotona, in the south of Italy, a schooP 
where natural philosophy, mathematics, acoustics, etc., 
were taught. He also devoted some attention to anatomy, 
to embryology, to physiology and to therapeutics. Accord- 
ing to his views of what constituted hygienic living a man 
should accustom himself to a diet of the simplest character, 
without meat. Pythagoras was a believer in the Chaldean 
doctrine that the uneven numbers possess a more important 
significance than the even, and that the number seven in 
particular has a special relationship to the phenomena 
of certain diseases; the crisis frequently falling on the 
seventh, fourteenth, or twenty-first day. Galen, it is said, 
expressed surprise that a man as sensible and learned as 
Pythagoras should have paid any attention to such trifles. 
Not a few of the disciples of Pythagoras were physicians, 

2 The word ' ' school, ' ' when employed in the strictly modern sense of that 
term, means an establishment regularly organized for the purpose of giving 
instruction. Here, however, it is intended to signify simply that certain places, 
like Cos, Crotona, Cnidus, etc., had become the rendezvous of men who desired 
to cultivate — some as teachers, others as disciples or pupils — certain branches 
of knowledge, or certain doctrines. At a later period (third century B. C.) 
there was established at Alexandria, Egypt, a well-organized school of medi- 
cine closely resembling those of modern times. 



BEGINNINGS OF A RATIONAL SYSTEM 75 

and when the brotherhood (if such it may be called) broke 
up, as it did in the fifth century B. C, these men traveled 
about from one Grecian city to another; from which fact 
they were given the name of * * periodeuts " or ambulant 
physicians. Crotona was also celebrated as the birthplace 
of Milo, the athlete. 

Democedes, who was a contemporary of Pythagoras, but 
not one of his disciples, was a native of Crotona. Dion 
Cassius, the author of a Roman history, ranks him and 
Hippocrates as the two most eminent physicians of 
antiquity. Daremberg, who derived his facts from the 
works of Herodotus, gives the following account of the 
adventures of Democedes : — 

Being unable to bear any longer the frequent anger and harsh 
treatment of his father, Calliphon, Democedes left Crotona, and 
settled in practice at Aegina, on the Saronic Gulf, not far from 
Athens. Almost from the very start he attained marked success, 
and already in the second year of his residence in Aegina he was 
made the recipient of a pension of one talent (equal to about £240. 
or $1200.) out of the public treasury. During the following year 
he was induced, by the offer of a larger pension (100 minae, or 
about $3000.) to settle in Athens; and, a year later, he accepted 
a still larger remuneration from Polycrates, the tyrant of Samos. 
Having accompanied the latter on a trip to Sardis, the capital of 
Lydia, in Asia Minor, he fell a prisoner into the hands of the 
governor of that city, and was made by him a slave. Not long 
afterward Darius gained possession of this governor's or satrap's 
property, including all his slaves; and thus, despite all his efforts 
to conceal his profession through fear that a knowledge of it on 
the part of the king might prolong his bondage indefinitely, 
Democedes was unable to do so. The discovery came about in the 
following manner. During a hunting trip Darius broke his ankle. 
He called to his assistance the court physicians, who were esteemed 
the most skilful that could be found in all Egypt, but they failed 
to give him relief. By the violence of their manipulations they 
rather made matters worse. For seven days and nights his 
sufferings were so great that he was unable to obtain any sleep. 
Finally, on the eighth day, one of the court attendants having told 
Darius that there was a Greek physician among the slaves, 
Democedes was sent for, and he appeared before the king clad in 



76 GROWTH OF MEDICINE 

rags and with chains on his ankles. When asked whether he knew 
anything about medicine he denied such knowledge, being fearful 
that the discovery of the truth about himself would stand in the 
way of his ever getting back to Greece. Darius, perceiving that he 
was dissimulating, ordered the attendants to fetch the whips and 
pinchers. Whereupon Democedes made up his mind that he had 
better confess the truth. He accordingly told the king that, while 
not possessing a thorough knowledge of the healing art, long 
association with a physician had familiarized him more or less 
with the subject. The king then asked him to take charge of the 
case. Democedes, following the treatment adopted by the Greek 
physicians in similar conditions, applied soothing remedies and 
soon succeeded in procuring sleep for the suffering king. Event- 
ually he obtained a complete cure, and Darius, who had made up 
his mind that he would never again be able to use his limb, was 
naturally delighted with the result. He loaded Democedes with 
gifts, and, being charmed with his conversation, made him sit at 
the royal table and did everything possible to render court life 
attractive; but liberty was denied him, which was the one thing 
that Democedes most ardently desired. The only use which the 
latter made of the great influence which he had obtained over 
Darius was to save the Egyptian physicians from the death by 
crucifixion which the king had decided to inflict upon them for 
their lack of skill. 

The means of escape finally presented themselves to Democedes 
in a most unexpected manner. Atossa, who was the wife of Darius 
and also the daughter of Cyrus, was afflicted with a swelling of 
the breast which developed into an abscess and began to burrow 
into the neighboring tissues. After, for a time, concealing the 
trouble through a sense of false modesty, she made up her mind 
to consult Democedes. He had the good fortune to cure her of 
this malady in a relatively short time. As preparations were then 
being made to send a number of spies to Greece with instructions 
to examine the coast carefully for the purpose of determining at 
what points the defenses were sufficiently weak to render an attack 
by the Persians reasonably sure of success, Democedes asked 
permission of Darius to accompany these men as their guide. His 
request was granted; and, as soon as the expedition reached 
Tarentum in Calabria, he delivered the Persian spies into the 
hands of Aristophilides, the king of that country, and then fled 
in all haste to Crotona, his native city. Shortly afterward these 
Persians, having been set at liberty by Aristophilides, made the 



BEGINNINGS OF A RATIONAL SYSTEM 77 

attempt to capture Democedes and carry him off by main force, 
but the citizens of Crotona thwarted the attempt and compelled 
the men to return to Asia. Democedes then married the daughter 
of Milo, the athlete, and history furnishes no information regarding 
the subsequent career of this extraordinary man. 

Daremberg calls attention to certain excellent proverbs 
which may be found in the writings of the Greek poets and 
which are of some interest to physicians. The following 
may serve as examples of those most widely known : — * 

Joy is the best physician for fatigue. 

(Pindar, 522-442 B. C.) 

The good physician is he who knows how to employ the right 
remedies at the proper time ; the poor one, he who, in the presence 
of a serious illness, loses his courage, becomes flustered, and is 
unable to devise any helpful method of treatment. 

(Aeschylus, 525-456 B. C.) 

Physician, heal thyself. 

(Euripides, 400-406 B. C.) 



Advice given to Phaedra by her nurse :- 



If thou hast some ailment which thou dost not care to reveal to 
men, here are women who are competent to treat the condition 
properly. 

(Euripides.) 

Sleep is the physician of pain, 
and 

Death is the supreme healer of maladies. 

(Sophocles, 495-406 B. C.) 

In Plato's writings there are to be found a few passages 
in which this philosopher gives his views in regard to 
certain matters that are not without interest to modern 
physicians. The following extracts are of this nature: — 

There is not then, my friend, any office among the whole inhabi- 
tants of the city peculiar to the woman, considered as a woman, 

3 All of these are translations from the French. 



78 GROWTH OF MEDICINE 

nor to the man, considered as a man; but the geniuses are 
indiscriminately diffused through both: the woman is naturally- 
fitted for sharing in all offices, and so is the man; but in all the 
woman is weaker than the man. 

Perfectly so. 

Shall we then commit everything to the care of the men, and 
nothing to the care of the women ? 

How shall we do so ? 

It is therefore, I imagine, as we say, that one woman, too, is 
fitted by natural genius for being a physician, and another is not ; 
one is naturally a musician, and another is not. 

(From "The Republic" of Plato, translated by Spens.) 

But tell me with reference to him who, accurately speaking, is 
a physician, whom you now mentioned, whether he is a gainer of 
money or one who taketh care of the sick? and speak of him who 
is really a physician. 

One who taketh care, said he, of the sick. 

*********** 

Why then, said I, no physician as far as he is a physician, con- 
siders what is advantageous for the physician, nor enjoins it, but 
what is advantageous for the sick; for it hath been agreed that 
the accurate physician is one who taketh care of sick bodies, and 
not an amasser of wealth. Hath it not been agreed ? 

He assented. 

(Plato, 428-547 B. C, translated by Spens.) 

But Plato 's knowledge of huinan anatomy and physiology 
was very crude and in some instances decidedly fanciful. 
In corroboration of this statement the following extract 
from the * ' Timaeus ' ' may be quoted : — 

And on this account, fearing to defile the Divine nature more 
than was absolutely necessary, they [the junior gods] lodged man's 
mortal portion separately from the Divine, in a different receptacle 
of the body; forming the head and breast and placing the neck 
between, as an isthmus and limit to separate the two extremes. 

In the breast, indeed, and what is called the thorax, they seated 
the mortal part of the soul. And as one part of it was naturally 
better, and another worse, they formed the cavity of the thorax 
into two divisions (resembling the separate dwellings of our men 
and women), placing the midriff as a partition between them. 
That part of the soul, therefore, which partakes of fortitude and 



BEGINNINGS OF A RATIONAL SYSTEM 79 

spirit and loves contention they seated nearer the head between 
the midriff and the neck ; as it is the business of the reason to unite 
with it in forcibly repressing the desires, whenever they will not 
obey the mandate and word issuing from the citadel above. 

The heart, which is the head and principle of the veins as well 
as the fountain of the blood that impetuously circulates through 
all the members, they placed in a kind of sentry-house, that, in 
case of any outburst of anger, being informed by the reason of any 
evil committed in its members, owing either to some foreign cause, 
or else internal passions, it (the heart) might transmit through 
all its channels the threatenings and exhortations of reason, so 
as once more to reduce the body to perfect obedience, and so permit 
what is the best within us to maintain supreme command. 

But as the gods foreknew, with respect to the palpitation of the 
heart under the dread of danger and the excitement of passion, 
that all such swellings of the inflamed spirit would be produced 
by fire, they formed the lungs to be a sort of protection thereto; 
first of all, soft and bloodless, and next internally provided with 
cavities perforated like a sponge, in order to cool the breath which 
they receive, and give the heart easy respiration and repose in 
its excessive heat. On this account, then, they led the channels 
of the windpipe into the lungs, which they placed like a soft cushion 
round the heart, in order that when anger rises in it to an extreme 
height it might fall on some yielding substance, and, so getting 
cool, yield cheerfully and with less trouble to the authority of 
reason. 

(Plato's "Timaeus," translated by Henry Davis.) 

Alcmaeon, Empedocles, Diogenes of Apollonia, Anaxa- 
goras and Pausanias, whose names are mentioned above 
in the list of eminent men who flourished during the golden 
age of Greek history, are entitled to further consideration. 
Alcmaeon of Crotona was a contemporary and disciple of 
Pythagoras. He was specially devoted to the study of 
anatomy and physiology, and is credited with the distinc- 
tion of having been the first person to dissect animals for 
the purpose of learning the formation of the different parts 
of their bodies. With the exception of a few fragments 
that are to be found scattered throughout ancient medical 
literature, Alcmaeon 's writings have all been lost. The 
discovery of the optic nerve is credited to him, and 



80 GROWTH OF MEDICINE 

Neuburger states that he deserves still greater credit for 
having been the first to declare that the brain is the central 
organ of all intellectual activity. 

Of all the disciples of Pythagoras, Empedocles attained 
the greatest celebrity. He flourished about 444 B, C, his 
residence being at Agrigentum, in Sicily. Much of his 
reputation appears to have been due to the mystery which 
surrounded many of* his actions. He was even reputed 
to have brought again to life persons who were believed 
to be dead. His works were all in verse, but only fragments 
have come down to us. He placed the seat of hearing in 
the labyrinth of the temporal bone. His death occurred 
in Peloponnesus at the age of sixty, as the result of an 
accident. 

Anaxagoras was born at Clazomenae, in Ionia, 500 B. C. 
He was the teacher of Euripides, the Athenian poet, and 
Pericles, the greatest of Athenian statesmen. He and his 
contemporary, Diogenes of Apollonia, in Crete, devoted a 
great deal of attention to the study of anatomy. They 
dissected animals and made some genuine discoveries; 
Anaxagoras noting the existence of the lateral ventricles 
of the brain, and Diogenes furnishing a description — ^very 
erroneous, it is true — of the vascular system of the body. 
Puschmann says that, according to Aristotle, the philoso- 
phers of that period considered the study of man and his 
diseases the most important one to which they could 
devote their time and thoughts. Many of them indeed 
had been educated as physicians, and not a few were actual 
practitioners of medicine. 



CHAPTER VII 
HIPPOCRATES THE GREAT 

Hippocrates was bom in 460 B. C. in the city of Cos, on 
the island of the same name. Both his father and grand- 
father were eminent physicians, descendants of Aescu- 
lapius. On his mother's side he traced his descent from 
Hercules. The famous painter, Apelles, also hailed from 
the city of Cos. To distinguish Hippocrates from an 
earlier individual of the same name he was called 
Hippocrates II., or the Great. He is said to have received 
his first instruction in medicine at the school of the 
Asclepiadae in his native city, but his frequently repeated 
and very favorable comments on the teachings of the 
Cnidian schooP have led some to believe that he may have 
received a part of his medical training at the latter 
institution. At a later period of his life his popularity as 
a teacher of medicine, in the school of the Asclepiadae at 
Cos, attracted many pupils to that city. In accordance 
with a custom which prevailed among the physicians of 
ancient Greece, Hippocrate^, at the beginning of his 
career, spent quite a long time in Athens, and then traveled 
about, from one city to another, in the character of a 
periodeutic or itinerant physician. In this way, as he 
himself reports in some of his writings, he visited Thessaly, 
Thrace, the Island of Thasos, Scythia, the countries 
bordering on the Black Sea, and even Northern Egypt. 
Owing largely to domestic troubles he left his home in 
Cos, during the latter part of his career, and removed 
to Thessaly. He died about 370 B. C. at Larissa, at an 

1 The city of Cnidus was situated very close to the Island of Cos, on a 
peninsula that projects from the coast of Caria, Asia Minor. 



82 GROWTH OF MEDICINE 

advanced age. Soranus of Ephesus, the celebrated 
obstetrician, reported that in his time (second century 
A. D.) the tomb of Hippocrates was still standing, and 
that it had been taken possession of by a swarm of bees 
whose honey was far-famed for its efficacy in curing ulcers 
of the mouth in children. 

Among the pupils of Hippocrates were his two sons, 
Draco and Thessalus, and his son-in-law, Polybus. 
Thessalus, in the capacity of a military surgeon, accom- 
panied Alcibiades on his expedition to Sicily, and later 
in his career he served as private physician to Archelaus, 
King of Macedonia. It is also believed that a number of 
the writings in the Hippocratic collection are from his 
pen. On the other hand, it is a well-established fact that 
Polybus is the author of a few of these treatises. When 
Hippocrates gave up the work of teaching, his son-in-law, 
who was at that time engaged in private practice in Cos, 
was chosen his successor in the school. 

Among the many anecdotes which are related of Hip- 
pocrates, there is one which may with propriety be repeated 
here : — 

On the occasion of a visit to Abdera, in the northern part of 
_ Thrace, Hippocrates was requested to examine into the mental 
condition of the philosopher Democritus, who was thought by his 
narrow-minded countrymen to be insane. Hippocrates found him 
deeply engrossed in the study of natural philosophy and asked him 
what he was doing. Democritus replied that he was investigating 
the foolishness of men. Whereupon Hippocrates reported that he 
considered Democritus the wisest of men. (Pagel.) 

No better evidence of the true greatness of a man can be 
furnished than that which is afforded by the praise of his 
contemporaries in the same rank or walk of life ; and when 
the appreciation comes from such men as Plato and 
Aristotle, it constitutes an absolute guarantee that it is 
well and honestly earned. To Hippocrates belongs the 
singular honor of having won unstinted praise from both 
of these great philosophers, Aristotle giving him the title 
of ''Hippocrates the Great," and Plato comparing him 



HIPPOCRATES THE GREAT 83 

to those famous sculptors, Polyclytus and Phidias. His 
writings and those of the members of his family who were 
associated with him in the work of promoting a knowledge 
of medicine were most carefully preserved by his successors. 
When the Ptolemies began to establish libraries at Alex- 
andria, Egypt (285 B. C), and manifested a decided 
readiness to purchase the works of the most celebrated 
authors, copies of the Hippocratic writings were among 
those which found their way to that city. This eagerness 
on the part of the Kings of Egypt to purchase books or 
manuscripts stimulated unscrupulous persons to attribute 
to celebrated authors not a few of these works which they 
offered for sale. The librarians, whose duty it was to 
guard against such frauds, were not sufficiently well 
informed to prevent them; and thus there were accepted, 
as genuine productions, a few books which could not 
possibly have been written by those to whom they were 
attributed. The collectiou of Hippocratic writings did not 
escape this fate, and the evil was also further aggravated 
by the fact that copyists and incompetent editors made all 
sorts of emendations and additions on their own respon- 
sibility. Thus, it is not surprising that a collection which 
originally contained only the writings of Hippocrates and 
his immediate family, should in course of time have become 
expanded, not only by such alterations as have just been 
described, but also by the addition of entire works that had 
been written by others. At the beginning of the third 
century B. C, the Ptolemies appointed a committee of 
learned men in Alexandria to examine carefully the 
treatises reputed to be the work of Hippocrates and to 
make a collection of those which appeared to them to be 
genuine. They performed this task to the best of their 
ability, but the result showed that they lacked the necessary 
critical powers; and consequently during the past 2000 
years repeated attempts have been made to do what they 
failed to accomplish, but these efforts have only succeeded 
in part. The French edition prepared by Emile Littre, the 
distinguished member of the French Academy of Medicine, 
and published in the years 1839-1861, was, until quite 



84 GROWTH OF MEDICINE 

recently, universally accepted as embodying the best results 
of modern research and criticism with regard to this 
difficult question. But since 1861 other scholars have been 
busily engaged in perfecting the text of the Hippocratic 
writings, and their criticisms and suggestions have made 
it possible to publish a German version of this great work 
which is of more practical value to physicians than that of 
Littre, which forms a series of ten large volumes and is 
no longer easy to obtain. On the other hand, the German 
version by Robert Fuchs (Munich, 1895-1900), in three 
volumes of moderate size, while in no respect inferior to 
the famous French translation, is superior to it in several 
particulars: it is better adapted to the needs of the 
ordinary practitioner of medicine, it embodies the results 
of the excellent critical work done since 1861 {e.g., by 
Ermerins of Utrecht, Daremberg of France, and Ilberg 
and Kiihlewein of Germany), and it costs very much less 
than its French predecessor and rival. 

As regards the question of authenticity of the treatises 
contained in the work known as *'The Hippocratic Writ- 
ings" the most important thing to be determined is, not 
whether this or that book or chapter in the collection was 
really written by Hippocrates, but whether the work in 
its totality gives a correct and fairly complete picture of 
the best medical thought and practice of the period during 
which Hippocrates lived; and to this question a decided 
answer in the affirmative may be given. As to the broad 
question of authenticity. Max Neuburger, the distinguished 
Viennese author of the latest and most authoritative 
history of medicine, thus expresses himself : — 

Notwithstanding the extremely small quantity of evidence which 
the so-called ''Hippocratic Writings" themselves furnish as to 
who were the writers of the individual treatises and as to what 
Hippocrates himself actually did or thought; and although it is 
true that portions of the collection often contradict one another 
both in regard to questions of theory and also in regard to methods 
of treatment, one fact stands out conspicuously, viz., that the 
peculiar character of these writings both as a collection and taken 
separately, not only gives them a unique position in medical 



HIPPOCRATES THE GREAT 85 

literature, but reveals plainly that they owe their origin directly 
or indirectly to the powerful influence of a single commanding 
personality. 

As to the manner of teaching medicine, the Hippocratic 
writings show that, at the time which is here under con- 
sideration, the mystical features had almost completely 
disappeared. The science was now taught by regular 
instructors, who agreed for a stipulated fee to take charge 
of the pupil's entire training from the beginning to the 
end of the course. Candidates who were in delicate health 
were discouraged from entering upon the career of a 
physician, and those who had completed the regular course 
of instruction were sent out into the world equipped with 
certain general principles for their future guidance in 
actual practice. Some of these bear a close resemblance 
to the principles of a similar nature which had been 
established at a much earlier period in India. For example, 
the importance of cleanliness of the person is strongly 
emphasized. Reticence, as well as courtesy, is classed as 
one of the virtues of a good physician. 

He who acts hastily and does not take sufiBcient time for 
consideration is sure to be criticised unfavorably. If he breaks 
out too readily into laughter he will be thought uncultivated. 

In another of the Hippocratic writings the physician is 
urged not to indulge in too much small talk, but to confine 
his conversation as much as possible to matters relating 
to the treatment of the disorder. 

In his business dealings the physician, like a genuine philosopher, 
should not display a greed for money, he should assume a modest 
and dignified attitude, he should appear quiet and calm, and his 
speech should be simple and straightforward and free from all 
superstition. 

For their knowledge of human anatomy the physicians 
of that period were obliged to depend on the dissection of 
animals. Specimens of human bones were of course easily 
accessible, and consequently the descriptions which are 



86 GROWTH OF MEDICINE , 

given of these structures are quite accurate, even as 
regards many of the finer details. 

It would be a very difficult matter to furnish here, within 
a limited space, a reasonably clear exposition of the views 
held by Hippocrates with regard to human physiology and 
pathology. Empedocles, a Greek physician and high priest 
of Agrigentum, in Sicily, who was born about 490 B. C, 
founded a system of philosophy on the theory that the 
universe is made up of four elements — fire, air, earth and 
water; and he maintained that fire is the essence of life, 
the other elemei^ts forming the basis of matter. It was 
upon this system that Hippocrates founded his own theories 
of life, death and disease, but he disagreed with Emped- 
ocles in regard to the manner in which the four elements 
are united, his own belief being that they form together 
a genuine mixture, whereas Empedocles maintains that 
their union represents merely a mechanical aggregation 
of separate atoms. He also held that these original four 
elements, to which he gave the names of heat, cold, dryness 
and moisture, were represented in the human body by the 
following four cardinal fluids or '^ juices": blood, mucus 
or phlegm, black bile and yellow bile.^ He maintained, 
further, that when these elements are mingled harmo- 
niously so as to produce a state of perfect equilibrium, 
health resulted; but that when some deficiency of one or 
more of them, or some lack of harmony between them in 
other respects, occurs, disease is produced. At a later date, 
a fifth element — wind or air (pneuma) — ^was added to 
the other four; and when Hippocrates was unable to 
account satisfactorily for certain phenomena of disease, 
he was wont to refer the phenomenon observed to divine 
interference. 

This brief exposition of the physiological and patho- 
logical views held by Hippocrates, incomplete and super- 
ficial as it is, mil have to suffice. Those who wish to 
acquire a more profound knowledge of the subject should 
consult some of the larger treatises like those of Darem- 

2 Black bile, it was believed, comes from the spleen, while the yellow variety 
is a product of the liver. 



HIPPOCRATES THE GREAT 67 

berg, of Max Neuburger, and of Pagel, as well as the 
sections devoted to these subjects in the French (Littre) 
and the German (Fuchs) versions of the Hippocratic 
writings. At every step in such a study, the modern 
physician will encounter ideas and individual terms which 
he will have great difficulty in comprehending; and later 
on, as he reads the sections which deal with the more 
practical matters of the medical art, he will be astonished 
to find that Hippocrates was a most acute and trustworthy 
observer of the phenomena of disease, a remarkably clear 
writer, and a standard-bearer of very high aims. 

In the examination and treatment of the sick the physi- 
cians of ancient Greece were highly trained. They paid 
very close attention to the patient's account of his 
symptoms, but it was to the physical examination of the 
diseased body that they attached the greatest importance. 
They noted with extreme care the color and other peculiari- 
ties of the skin and mucous membranes, the condition of 
the abdomen, and the shape and movements of the thorax ; 
they tested the patient's temperature by placing the hand 
upon the body ; and all the excretions were subjected to the 
closest scrutiny. By means of palpation they were able 
to determine not only the size of the liver and spleen, but 
also the changes which occur in the form of these organs 
in the course of certain diseases. They utilized succussion 
both as an aid to diagnosis and as a means of favoring the 
breaking through of pus into the bronchial tubes. They 
were familiar with the pleuritic friction sound and with the 
finest rales, which they compared to the • creaking of 
leather or ''the noise of boiling vinegar." In their 
descriptions of these sounds it is distinctly stated that 
the examiner's cartas kept tightly pressed against the 
patient's chest. ^ 

In speaking of the accounts of individual diseases which 
appear in the Hippocratic writings, Puschmann says that 
they are evidently based 6n cases actually observed in 
practice, and that they are admirably written. It is in the 
laws which they have laid down with regard to the treat- 
ment of disease, however, that the Hippocratic writers have 



88 GROWTH OF MEDICINE 

gained their chief distinction, a distinction which will 
belong to them through all time. 

The physician should be the handy man of Nature, and he should 
strive to aid and to imitate her efforts to effect a cure. His first 
care should be to remove, so far as is possible, the causes of the 
disease ; and then, in the conduct of the treatment, he should keep 
in view at all times the special circumstances of the case, giving 
closer attention to the patient than to the disease itself. In short, 
he should aim at being useful, or at least he should be careful not 
to do any harm. 



1^ 



CHAPTER VIII 

BRIEF EXTRACTS FROM SOME OF THE 
HIPPOCRATIC WRITINGS 

The statements which have thus far been made in these 
pages with regard to Hippocrates are only of a general 
character, and it may therefore be interesting for the 
reader to have placed before him a few selected extracts 
from the writings which have formed the basis of these 
statements. The English text here used is a translation 
of the German version of Robert Fuchs, to which reference 
has already been made. It would have been a pleasure to 
use for this purpose the admirable English translation of 
Frederick Adams, published in 1849 under the auspices 
of the Sydenham Society of Great Britain; but, unfortu- 
nately, this version contains only a part of the Hippocratic 
writings, and, besides, this writer did not at that time 
have the advantage of consulting the French and German 
versions which have been published since 1849. 

It seems almost unnecessary to state here, by way of 
preface, that the small amount of space which may properly 
be devoted to these extracts renders it necessary to present 
many of them in a very fragmentary and disconnected 
form, merely enough text being furnished to give the 
reader some slight idea both of the manner in which 
Hippocrates and those associated with him handled certain 
medical topics, and also of the views which they entertained 
with regard to the same subjects. 

BRIEF EXTRACTS FROM SOME OF THE HIPPOCRATIC WRITINGS 

Aphorisms. — I. — 1. Life is short, art is long, the right moment 
lasts but an instant,^ experience is often deceptive, a correct 
judgment is hard to reach. 

1 Daremberg (Hist, de la Mid.) makes the following comments on this 



90 GROWTH OF MEDICINE 

6. For the most serious ills extreme measures cautiously- 
employed are the best. 

8. When an illness has reached its acme the lightest diet must 
be prescribed. 

11. During the exacerbations nourishment should be withheld, 
for at these times the giving of food is harmful; and in illnesses 
which are characterized by periodic paroxysms it is also best not 
to give food during the paroxysms. 

13. Old people bear fasting very well, and the same is almost 
true of persons of mature age ; but young individuals do not bear 
abstinence from food so well, and this is particularly the case with 
children, especially with those of a lively disposition. 

24. In acute illnesses laxative remedies should rarelv be admin- 
istered, and then only in the early stage of the malady and with 
great caution. 

II. — 2. When sleep puts an end to delirium it is a good sign. 
3. When either sleep or wakefulness oversteps the proper 
limit it is harmful. 

5. Causeless depression is an indication of some disorder. 

19. In acute diseases the prognosis as regards either death or 
recovery, is very uncertain. 

44. Corpulent persons are more likely than those who are 
slender to die a quick death. 

V. — 7. When epileptic attacks occur before the age of puberty, 
a change for the better may be looked for ; but if the disease makes 
its first appearance when the individual has already reached his 
twenty-fifth year, he may be expected to carry the affliction with 
him to the time of his death. 

9. Consumption most commonly attacks persons who are 
between the ages of eighteen and thirty-five. 

14. When a consumptive person has attacks of diarrhoea, a 
fatal issue may be anticipated. 

VII. — 1. If in the course of an acute illness the extremities 
grow cold, it is an unfavorable sign. 

sentence: "How many are the occasions when we physicians would have it 
in our power to avert death, or at least to postpone it for a few hours, if we 
would only engrave upon our memories these words of the old man of Cos I 
'What a cruel responsibility rests upon those whose duty it is to summon the 
doctor at the proper moment! And how great must be the remorse if he fails 
to arrive in time ! ' On the other hand, how wise is the remark of Celsus : 
'The best practitioner is he who never loses sight of his patients.' " 



EXTRACTS FROM HIPPOCRATIC WRITINGS 91 

14. If, after a blow upon the head, stupefaction or delirium 
manifests itself, the outlook is bad. 

[The total number of the aphorisms is 422.] 

The Book of Prognoses. — 1. I believe that it is best for a 
physician to acquire a certain degree of practice in the power to 
predict how the disease is likely to terminate ; for if, when he is in 
-the presence of his patient, he is able to state, not only what is 
going to take place in the future course of the malady, but also 
certain other facts which relate to the past behavior of the attack, 
but which were omitted from the account given to him of the 
previous history of the case, he will impress the patient with the 
belief that he is thoroughly familiar with the disease from which 
the latter is suffering, and that consequently he is a physician 
in whose knowledge and skill he can place entire confidence. Then, 
besides, he will be the gainer in another respect: his knowledge 
of what is likely to be the subsequent course of any given disease 
will enable him to treat it in the most effective manner. The 
ability to restore all his patients to health would of course be a 
greater power than that of correctly predicting the future behavior 
of a malady in any particular case. This ability, however, is clearly 
unattainable. One patient dies by reason of the severity of the 
disease itself, even before the physician is called in; a second one, 
shortly after the latter 's visit; and a third lingers on for a day 
or two after the doctor's arrival, dying before the latter 's art has 
had time to produce a beneficial effect in hindering the advance 
of the malady. The observation of these different events should 
enable the physician to become acquainted with the nature of the 
diseases observed, and — more particularly — to learn to what extent, 
in individual instances, they manifest a strength greater than the 
patient's power of resistance. At the same time, he must not 
forget that in many cases divine interference plays a part in 
directing the course of the disease. And thus, if he pays heed to 
all these things, the physician will merit the confidence of his 
patients and will gain the reputation of being a clever and skilful 
practitioner. 

IV. — It is better when the physician, upon the occasion of his 
first visit, finds the patient lying upon one side, with his hands, 
neck and thighs slightly flexed, and the entire body placed in a 
perfectly natural position, like that which a man assumes in bed 
when he is in a state of health. It is not so well when the physician 
finds the patient lying upon his back, with his hands, neck and 



92 GROWTH OF MEDICINE 

thighs extended. But if the latter is found curled up and sliding 
down toward the foot of the bed, this is an unfavorable sign. 
Finally, if he is found with rather cold feet projecting from under 
the bedclothes, and with his arms outstretched and his neck and 
thighs exposed, his condition may be considered dangerous, for 
this attitude of the body betokens an agitated state of the mind. 
If the patient sleeps with his mouth constantly open, lying upon 
his back and with his thighs strongly flexed and widely separated, 
it may be assumed that death is near at hand. If he lies upon 
his belly when it is known that he was not in the habit of sleeping 
in this manner before he was taken ill, the inference is warranted 
either that he is delirious or that he is suffering from pain in the 
lower part of his abdomen. Finally, if the patient shows an 
inclination to maintain a sitting posture while the malady is still 
in an active stage, this feature must be looked upon as a grave 
symptom and especially so in inflammation of the lungs. 

XIV. — Pus that has a whitish color and a uniform consistency, 
that is smooth and free from clumps, and the odor of which is only 
slightly unpleasant, is the least harmful. On the other hand, a 
pus which possesses the opposite characteristics is very dangerous. 

XL. — Severe pain in the ear, if associated with a persistent 
fever is dangerous, for the patient may become delirious and die. 

[There are 47 chapters in the Book of Prognoses; in 
addition, there are 740 separate sections in the Coan 
Prognoses {Praenotiones Coacae).] 

The Epidemic Diseases. — ^VI. — 4. The wife of Agasis had 
already as a young girl been troubled with shortness of breath. 
After she had reached womanhood, and soon after she had given 
birth to a child, she lifted a heavy weight. Immediately she heard, 
as she believed, a noise in her chest, and on the following day she 
experienced some difficulty in breathing and a certain amount of 
pain in her right hip. These two symptoms were so related to 
each other that, whenever the pain in the hip made its appearance, 
she immediately became conscious that she was short of breath, 
and, vice versa, whenever the pain ceased, she found that her 
breathing became easier. Her expectoration was of a foamy 
character and of a rather bright color, but, after it had been 
allowed to stand for a short time, it looked like diluted biliary 
matter that had been vomited. The pain in the hip troubled her 
chiefly when she performed manual work. She was advised to 



EXTRACTS FROM HIPPOCRATIC WRITINGS 93 

abstain from eating garlic, pork, mutton, and beef, and not to 
call loudly or to get excited while she was engaged in work. 

VII. — 7. The wife of Polycrates became feverish during the 
summer season, and about the time of the dog star. In the morning 
her breathing was somewhat embarrassed, but after mid-day it 
became more difficult and at the same time more rapid. From 
the very beginning of the illness she had a cough and expectorated 
purulent masses. In the throat and along the course of the trachea 
one could hear a hoarse whistling sound. The patient's face had 
a healthy color, and over the two halves of the jaw there was some 
redness, not of a deep hue but rather fresh and bright. A little 
later her voice also became hoarse, she began to show some 
emaciation, raw spots developed over the fleshy parts of her hips, 
and the surface of the body grew more moist than it had been 
before. On the seventieth day the outward evidences of fever 
became much less noticeable, but the respiration grew more rapid ; 
and from that day to the time of her death, five or six days later, 
she was obliged to remain in a sitting posture. Toward the end 
the tracheal rale grew louder, and dangerous sweats occurred, but 
the patient never lost her expression of intelligence. 

Fractures. — II. — 9. In the human body the foot, like the hand, 
is composed of a number of small bones. As they are not easily 
broken it may safely be assumed, when such a case of fracture 
comes under observation, that some pointed or unusually heavy 
object had caused the lesion, and that the surrounding soft parts 
must necessarily have been injured at the same time. (Injuries 
of this nature will be discussed in a later section.) But if any 
part of this bony framework is pushed out of its natural position — 
whether this take place in one of the toes, or in one of the tarsal 
bones, it makes no difference — the dislocated part should be forced 
back into position in the manner recommended in section XXIV. 
In its essential features the treatment consists in the employment 
of wax plaster, compresses, and bandages, exactly the same as is 
done in the treatment of fractures of the long bones, but without 
splints. The same rules hold good with regard to the degree of 
pressure to be applied, and every third day the dressings should 
be renewed. On each occasion of such renewal the patient should 
be questioned with regard to the sensations which he feels after 
the bandages have been applied, and if necessary they should be 
readjusted in accordance with the nature of the answers which 
he gives. The great majority of these injuries heal completely in 
twenty days. The exceptional cases are those in which the fracture 



94 GROWTH OF MEDICINE 

involves a bone that stands in immediate relation with the bones 
of the leg. It is advisable, however, that the patient should remain 
in bed during the period mentioned; for, in not a few instances, 
the persons thus affected, failing to appreciate the gravity of the 
injury, walk about before the parts have really healed; and then, 
for an indefinite period of time, they are frequently reminded in 
a painful manner of the injury which they received. There is 
nothing astonishing in this when the fact is recalled to mind that 
the feet support the entire weight of the body. 

[Forty-eight chapters or sections, some of them of 
considerable length, are devoted to the subject of fractures. 
The authorities are almost unanimous in stating that this 
portion of the so-called Hippocratic writings was written 
by Hippocrates himself. Malgaigne and Petrequin, two of 
the most competent French writers on questions relating 
to surgery, declare that the treatises written by Hip- 
pocrates on fractures and dislocations (the two forming 
in reality one continuous treatise) are the best and most 
complete books ever written by a physician.] 

Wounds of the Head. — 10. The physician should, first of all, 
before touching the patient's head, inspect carefully the wound 
and surrounding parts. After noting whether the injury has been 
inflicted upon a strong or a weak portion of the head, he should 
ascertain whether the hair has been cut by the fall or the blow, 
and whether portions of it have penetrated into the wound. In 
the latter event he should express his fear that the skull at this 
point has been laid bare and has perhaps even received some 
material injury. He should make this statement before he has 
touched or probed the wound. Then afterward he should proceed 
to a physical examination of the injured parts, in order that he 
may learn positively whether the overlying soft tissues have or 
have not been separated from the bone. If simple inspection 
reveals the fact that the skull has been laid bare, well and good; 
but, if the real condition is not thus revealed, he should not hesitate 
to employ the probe. If he finds that the soft parts have been 
separated from the bone and that the latter has been more or less 
injured, he should continue this more minute exploration until 
he shall have ascertained to just what extent and in what manner 
the skull has been injured, and what measures are required to 
remedy the damage ; in brief, he should make the diagnosis. At the 



EXTRACTS FROM HIPPOCRATIC WRITINGS 95 

same time, however, he should not neglect to question the patient 
very closely about the manner in which the wound was inflicted, 
for in this way he may be able to infer the existence of a contusion, 
or even a fracture of the skull, of which no material evidences are 
discoverable. Important information may also be gathered by 
passing the hand over the seat of injury in the bone, — information 
which the employment of the probe is not competent to convey, 

[Twenty-one additional chapters are devoted to wounds 
of the head, every possible phase of the subject being 
handled by Hippocrates in the most careful and thorough 
manner.] 



CHAPTER IX 

THE STATE OF GREEK MEDICINE AFTER THE 
EVENTS OF THE PELOPONNESIAN WAR; THE 
FOUNDING OF ALEXANDRIA IN EGYPT, AT 
THE MOUTH OF THE NILE ; AND THE DEVELOP- 
MENT OF DIFFERENT SECTS IN MEDICINE 

Up to the time when war broke out between Sparta and 
Athens (431 B. C), the latter city had for many years 
easily held the supremacy, not merely in everything 
relating to the science and art of medicine, but also in all 
other branches of learning and especially in the arts of 
sculpture, painting and architecture. At the time named 
above came the beginning of her downfall. For a period 
of about twenty-one years she struggled against disasters 
of all sorts. 

The Plague at Athens, the first Recorded in History. — 
Shortly after the war began — a war engendered by the 
bitter jealousy of Sparta over the ever increasing ascend- 
ancy of her rival — the latter city was visited by a devas- 
tating plague, the first European pestilence that has been 
recorded in history. Thucydides, who wrote the history 
of the Peloponnesian War, gives a most lucid description 
of this plague of Athens, from which I shall copy certain 
portions. 

It first began, it is said, in the parts of Ethiopia above Egypt, 
and thence descended into Egypt and Libya and into most of the 
King's country. Suddenly falling upon Athens, it first attacked 
the population in Piraeus, — which was the occasion of their saying 
that the Peloponnesians had poisoned the reservoirs, there being 
as yet no wells there, — and afterward appeared in the upper 
city, when the deaths became much more frequent. All speculation 



DEVELOPMENT OF SECTS IN MEDICINE 97 

as to its origin and its causes, if causes can be found adequate to 
produce so great a disturbance, I leave to other writers, whether 
lay or professional ; for myself, I shall simply set down its nature, 
and explain the symptoms by which perhaps it may be recognized 
by the student, if it should ever break out again. This I can the 
better do, as I had the disease myself, and watched its operation 

in the case of others People in good health were all of a 

sudden attacked by violent heats in the head and redness and 
inflammation in the eyes, the inward parts, such as the throat or 
tongue, becoming bloody and emitting an unnatural and fetid 
breath. These symptoms were followed by sneezing and hoarse- 
ness, after which the pain soon reached the chest, and produced 
a hard cough. When it fixed in the stomach, it upset it; and 
discharges of bile of every kind named by physicians ensued, 
accompanied by very great distress. In most cases, also, an 
ineffectual retching followed, producing violent spasms, which in 
some cases ceased soon after, in others much later. Externally 
the body was not very hot to the touch, nor pale in its appearance, 
but reddish, livid, and breaking out into small pustules and ulcers. 
But internally it burned so that the patient could not bear to have 
on him clothing or linen even of the very lightest description; 
or indeed to be otherwise than stark naked. What they would 
have liked best would have been to throw themselves into cold 
water; as indeed was done by some of the neglected sick, who 
plunged into the rain-tanks in their agonies of unquenchable 
thirst; though it made no difference whether they drank little or 
much. Besides this, the miserable feeling of not being able to rest 
or sleep never ceased to torment them. The body meanwhile did 
not waste away so long as the distemper was at its height, but held 
out to a marvel against its ravages; so that when they succumbed, 
as in most cases, on the seventh or eighth day to the internal 
inflammation, they had still some strength in them. But if they 
passed this stage, and the disease descended further into the 
bowels, inducing a violent ulceration there accompanied by severe 
diarrhoea, this brought on a weakness which was generally fatal. 
For the disorder first settled in the head, ran its course from 
thence through the whole of the body, and, even where it did not 

prove mortal, it still left its mark on the extremities; 

some, too, escaped with the loss of their eyes Some died 

in neglect, others in the midst of every attention. No remedy was 
found that could be used as a specific; for what did good in one 
case, did harm in another Such was the nature of the 



98 GROWTH OF MEDICINE 

calamity, and heavily did it weigh on the Athenians ; death raging 
within the city and devastation without. 

(Translation of Richard Crawley; Dent & Sons, London.) 

Athens Ceases to be the Centre of Medical Learning. — 
It is safe to assume that one by one the more prominent 
of the physicians who had survived the events which have 
just been narrated, must have left Athens and taken up 
their abode in the various cities of Asia Minor and the 
neighboring islands, in Sicily, in Italy, etc. Hippocrates, 
who was thirty years old at the time when the plague broke 
out in Athens, appears not to have witnessed it. He 
practiced his profession and taught medicine in his native 
city; then he spent a certain number of years in traveling 
about as a peripatetic physician; and finally settled for 
the remainder of his life in Thessaly. But the length of 
each of these periods of his professional life is not men- 
tioned by any of the authorities. About forty years after 
the death of Hippocrates, Alexander the Great had already 
nearly completed his series of brilliant conquests, and was 
taking steps to found a city, or rather, a university, in 
which medicine was to take an organized shape as one of 
the great departments of human learning. 

It may be well at this point, however, to interrupt this 
narrative of the regular course of events for the purpose 
of considering very briefly how far the physicians of that 
period had advanced toward gaining a permanent and 
honorable position in their respective communities. 

The Degree of Esteem in which Physicians Were Held by 
Their Fellow Citizens and by the Governing Authorities 
During the Centuries Immediately Preceding the Christian 
Era, — ^We have at our command very little direct evidence 
bearing upon the question of the esteem in which physicians 
were held three hundred years B. C. by the communities 
in which they practiced their profession. We know posi- 
tively that the kings and princes of that period fully 
appreciated the value of the services which were rendered 
to them by the physicians (commonly Greeks) whom they 
employed. In the event of war they took with them men 
who were skilled both in surgery and in the treatment of 



DEVELOPMENT OF SECTS IN MEDICINE 99 

the ordinary ills of the body. One of the sons of Hip- 
pocrates, for example, served for some time in this 
capacity, and he is credited with the statement that *'the 
physician who wishes to obtain the best training in 
surgery should enter the service of the army." There 
were eight surgeons officially connected with the **ten 
thousand" whom Xenophon led back to Greece after the 
famous campaign in Asia Minor. The army of Alexander 
the Great was accompanied by the most celebrated surgeons 
of that period. Upon a bronze tablet found at Idalium, 
on the Island of Cyprus, there is an inscription which dates 
back to the fifth century B. C, and which commemorates 
the merits of a physician named Onasilos, who, aided by 
his pupils, rendered valuable services, without any remu- 
neration, during one of the wars of the Greeks; and in 
recognition of these services, the Government had bestowed 
upon him a stipend and had exempted him from taxation. 
It is further known that the Athenians lavishly heaped 
honors upon Hippocrates, initiating him at public expense 
into the mysteries of the Eleusinia, giving him a crown of 
gold, and distinguishing him in still other ways. These 
facts show how highly the rulers of that day appreciated 
the services of a competent physician; but, up to a com- 
paratively recent date, it has not been so easy to demon- 
strate what was his position in the esteem of the community 
at large. The discovery, not many years ago, of two 
inscriptions in Greek throw a certain amount of light upon 
this very point. One of these, which bears the date of 
388 B. C., states that its purpose is to commemorate the 
fact that the physician Euenor, who had been intrusted 
by the people with the work of supervising the preparation 
of all the drugs intended for use in the public hospital, 
had not only fulfilled his duty but had in addition spent 
large sums of his own money in the accomplishment of 
this work. Another inscription, which was unearthed in 
the Island of Carpathus, between Crete and Rhodes, and 
which is believed to date back to the end of the fourth or 
the beginning of the third century B. C, reads (in a some- 
what abbreviated form) as follows: **In view of the fact 



100 GROWTH OF MEDICINE 

that, for more than twenty years, Menocritus, the son of 
Metrodorus of Samos, has devoted himself with much zeal 
and self-sacrifice to the duties of his position as parish 
physician, living all this time in rather narrow circum- 
stances and not asking any pay for his services, we, the 
citizens of Brycontium, have resolved to erect in his honor, 
in the temple of Neptune, a marble column bearing an 
inscription that shall set forth these facts, to crown him 
with a wreath of gold, and to announce publicly, at the 
Aesculapian games, this our decision." As apropos of 
this subject I may be permitted to quote the following 
words from Plato's **The Republic" (Book 1, Chap. 18) : 
''Will you call the medicinal the mercenary art, if, in 
performing a cure, one earns a reward? No, said he." 

The Founding of Alexandria. — ^Alexander the Great, 
after subduing the Persians and the cities of Phoenicia, 
marched into Egypt and founded (331 B. C), at the mouth 
of the Nile, the city of Alexandria, In October of the same 
year he crossed the Euphrates and the Tigris and defeated, 
for the second time, the Persian hosts under Darius. 
Alexander was now the conqueror of Asia. During the 
following eight years he laid his plans most carefully for 
the consolidation of his great empire, the capital of which 
was to have been Babylon; but, while he was thus making 
provision for the welfare of his numerous subjects, who 
were of widely different tastes and aspirations, he suc- 
cumbed (323 B. C.) to a severe attack of malarial fever, 
aggravated by an excessive indulgence in wine on the 
occasion of some festivity. In the meantime Alexandria 
was developing rapidly into a great centre of learning in 
all the departments of human knowledge. The Ptolemies, 
beginning with Ptolemy Soter, who reigned over Egypt 
from 323 to 285 B. C, contributed greatly to this result. 
For a period of about 250 years Alexandria remained the 
centre around which revolved all that was best in the 
domains of medicine, philosophy, geometry, mathematics, 
history, etc. Money was spent lavishly in collecting the 
writings of all those authors who had distinguished them- 
selves in these different fields of learning, and no pains 



BEVELOPMENT OF SECTS IN MEDICINE 101 

were spared to secure correct versions of the different 
works; the septuagint version of the books of the Old 
Testament of the Bible being a conspicuous example of 
what the Ptolemies accomplished in this direction during 
the third century B. C. Every possible facility was offered 
at the same time for the giving and receiving of instruction ; 
and thus, with the immense library as a foundation of 
priceless value, the Museum at Alexandria became in every 
material respect a great university, the first one of which 
history gives us any fairly satisfactory information. 
Several years after the Museum library was established 
a second one of somewhat smaller proportions was 
organized in the Serapeum (Temple of Serapis). The 
example set by the Ptolemies was followed by Attains, 
King of Pergamum in Mysia, Asia Minor (241 B. C), and, 
before many years had elapsed, the great library of that 
city almost rivaled those of the Museum and Serapeum 
at Alexandria. It was the competition between these two 
royal collectors of books that led to the issuing of a decree 
that no more papyrus was to be exported from Egypt, and 
thus there was provided the stimulus which led to the 
discovery or invention of a new and better material on 
which books might be written — viz., Pergamentum (our 
parchment), a word coined from the name of the city in 
which it was invented. 

The Development of Different Sects or Schools of 
Medicine. — Up to the time of the death of Hippocrates 
medicine maintained the character of a single organized 
and harmonious body; but, when this great physician had 
disappeared from the scene and was no longer there to 
guide the further development of medical science and to 
keep his followers working shoulder to shoulder with a 
single spirit and purpose, this hitherto homogeneous body 
split up into sects or schools, each of which had some 
favorite doctrine the promulgation of which seemed to 
each group of adherents to be of great importance. There 
were at first two such principal groups, viz., the Dogmatics 
and the Empirics. The former was composed of those who 
laid great stress upon speculation or theorizing, — that is, 



102 GROWTH OF MEDICINE 

upon the use of the reasoning power, — and the latter of 
men who maintained that actual experience was the only- 
thing of any serious value. The respective leaders of 
these two groups or sects were Plato and Aristotle. 

In Raphael's celebrated painting, ''The School of 
Athens," these two heroes of philosophy are represented 
standing side by side — Plato with his right hand elevated 
and pointing toward heaven, while Aristotle is looking 
distinctly at the earth. Pictorially, the tendencies of the 
two schools of philosophy could not have been better 
represented. Plato's genius had taken its flight heaven- 
ward and was contemplating earthly things from this point 
of vantage ; his method being to ignore system and to look 
at everything with the eyes of purest love. ''Delightfully 
poetic, but thoroughly unprofitable speculation as to 
what constitutes scientific truth and perfected morality!" 
(Friedlaender.) 

Aristotle, whose father was a physician and a descendant 
of Aesculapius, was the hero and guiding spirit of those 
who based their philosophy on experience, on ascertained 
facts. Like his celebrated pupil, Alexander the Great, who 
brought whole nations under his sway, he too was a 
conqueror in every field of human knowledge. His ideas 
ruled supreme over the minds of men for thousands of 
years and to-day, although many of them are no longer 
accepted as valid, Aristotle himself is universally held to 
have been the greatest thinker and investigator who has 
ever lived upon this earth. (In chapter XIII, I shall have 
occasion to say something further regarding the Dogmatics 
and the Empirics.) 

Out of the teachings of Plato and Aristotle developed 
two schools of philosophy that exerted, in course of time, 
a great influence upon the minds of men and upon the 
growth of medical science. The schools referred to are the 
Epicureans and the Stoics. Epicurus (242-270 B. C), who 
gave his name to the first of these, taught that the highest 
good was happiness. 

The happiness he taught his followers to seek was not sensual 
enjoyment, but peace of mind as the result of the cultivation of 



DEVELOPMENT OF SECTS IN MEDICINE 103 

all the virtues. According to the teaching of his school virtue 
should be practiced because it leads to happiness; whereas the 
Stoics taught that virtue should be cultivated for her own sake, 
irrespective of the happiness it will ensure. Zeno (circa 370-260 
B. C), the founder of the Stoic philosophy, taught an ethical 
system according to which virtue consists in absolute judgment, 
absolute mastery of desire, absolute control of the soul over pain, 
and absolute justice. The kejmote of the system is duty, as that 
of Epicureanism is pleasure. (Sir "William Smith.) 

In addition to the sects named above, there was still 
another known as the Older Dogmatic School, which was 
composed of men who had been the direct followers of the 
great master, but who, forgetting altogether the practical 
teachings of Hippocrates with regard to the importance 
of experience, gave themselves up to all sorts of hypotheses 
and theories. Among the names of the earliest followers 
of this school one is astonished to find those of Thessalus 
and Draco, the sons of Hippocrates, as well as the name 
of Polybus, the latter 's son-in-law. Diodes of Carystos 
and Praxagoras of Cos, two of the most distinguished 
men of that period, were also among the earliest members 
of this dogmatic school. Diodes, who was one of the 
Asclepiadae, owed his celebrity in part to his contributions 
to our knowledge of anatomy and in part to the work which 
he had done in other departments of medicine. Unfortu- 
nately, all of these writings have been lost with the 
exception of a few fragments which came to light toward 
the middle of the nineteenth century. Praxagoras was also 
one of the Asclepiadae. He was distinguished, as has 
already been stated on an earlier page, by the fact that 
he — and not Aristotle, as is sometimes stated — was first 
to recognize the difference between arteries and veins, and 
also by the further fact that he called attention to the 
practical value of the pulse as an indication, in certain 
diseases, of the tone of the patient's bodily condition or 
vitality. 



CHAPTER X 

ERASISTRATUS AND HEROPHILUS, THE TWO 
GREAT LEADERS IN MEDICINE AT ALEX- 
ANDRIA; THE FOUNDING OF NEW SECTS 

Two of the most celebrated physicians of that period 
(305-280 B. C.) were Erasistratus and Herophilus, both 
of whom were distinguished as the founders of schools or 
sects of medicine at Alexandria. They had received their 
early training as physicians from Chrysippus, a widely 
known Stoic philosopher, who, according to Albert von 
Haller, had taught at the school of Cnidus and had also 
written on medical topics ; and, among the other teachers, 
it is stated that Anaxagoras of Cos had instructed 
Herophilus, and that Metrodorus, the son-in-law of Aris- 
totle, had performed the same service for Erasistratus. 
So far as fundamental principles are concerned, the schools 
founded by these two physicians at Alexandria differed 
very little from each other, and the men themselves also 
gained their distinction in very much the same branches 
of medical knowledge, both of them having made a number 
of original discoveries in anatomy and both of them having 
become eminent practitioners. 

Herophilus was born at Chalcedon, a Greek city on the 
Propontus, nearly opposite to Byzantium. We possess no 
knowledge whatever regarding the earlier years of his 
career, notwithstanding the fact that no fewer than four 
different men devoted their energies to the writing of his 
biography. The books themselves have been either lost 
or destroyed. Herophilus showed a decided leaning toward 
the study of anatomy, and his contributions to this branch 
of medicine are among the earliest which we possess. 



ERA8ISTRATUS AND HEROPHILUS 105 

I'erophilus strove to supply one of the most conspicuous 
;ficiencies in the Hippocratic system of medicine, viz., 
inadequate knowledge of the nervous system; and to this 
end he conducted a series of the most careful investigations, 
as a result of which he was successful in establishing 
several facts previously unknown. He described the mem- 
branes of the brain, the choroid plexus, the venous sinuses, 
the structure which bears his name, — the torcular Hero- 
phili, — the cerebral ventricles, and the calamus scriptorius ; 
he traced the course of the nerve trunks for some distance 
from their origin in the brain and spinal cord ; and it was 
he who established the fact that two different sets of nerves 
exist — one for conveying sensations to the brain and the 
other for producing motion. In addition, he investigated 
the corpus vitreum, the retina, the optic nerve, etc. He also 
called attention to the peculiar mode of construction of 
the duodenum, and to the fact that the walls of the arteries 
are thicker than those of the veins. Some idea of the 
accurate manner in which he carried on his anatomical 
researches may be gained from the fact that he noted the 
circumstance that the left vena spermatica occasionally 
originates in the vena renalis. 

Herophilus also gained distinction in the practical 
branches of medicine. According to Puschmann he laid 
the foundations for a scientific sphygmography. Thus he 
distinguished several varieties of pulse in accordance with 
the differences which he noted in its strength, regularity, 
degree of fulness, and rate of speed. He also must have 
had considerable experience in surgery, as is shown by his 
remark that a dislocation of the thigh, owing to the tearing 
of the ligamentum teres which necessarily accompanies 
such a dislocation, is likely to occur again in the same 
individual. In his writings relating to the practice of 
medicine, Herophilus upheld the principle that experience 
alone should be our guide, as theoretical considerations are 
not to be trusted. He is also credited with having said, in 
response to the question. Whom do you consider the best 
physician? "Him who knows how to distinguish what is 
attainable from what is unattainable. ' ' 



106 GROWTH OF MEDICINE 

Erasistratus, the contemporary of HeropMlus and his 
associate in the work of establishing at Alexandria a great 
anatomical and clinical medical school, was a native of 
Julis, in the Island of Ceos, not far from the coast of 
Attica. In the earlier part of his professional career he 
spent some time at the Court of Seleucus, the founder of 
the Syrian monarchy (312-280 B. C). This monarch, who 
had been one of Alexander the Great's distinguished 
generals, consigned the government of the eastern part 
of his vast kingdom to his son Antiochus. The latter fell 
ill about this time, and the most distinguished physicians 
of the Court were then called in to determine what was the 
nature of his malady and to decide upon the proper treat- 
ment. The patient grew more and more languid, showed 
complete indifference to all that took place about him, and 
steadily lost flesh. Erasistratus, who was one of the 
physicians summoned, observed his behavior very closely 
and soon noted the fact that, whenever Stratonice, his 
young and attractive stepmother, entered the sick room, 
Antiochus became agitated ; his face being flushed, his voice 
subdued, his pulse more rapid, and his eyes brighter, all 
of which signs of excitement disappeared when Stratonice 
left the room. From these phenomena this shrewd observer 
drew the inference that the patient was deeply but hope- 
lessly in love with his father's second wife. Accordingly 
he informed Seleucus that his son's illness was simply the 
result of having lost his heart to one who was unable to 
return his affection. Seleucus, who was much astonished, 
asked with deep interest who was the lady. ''My wife,'* 
replied Erasistratus, without an instant's hesitation. ''But 
tell me then," asked Seleucus, "would you be willing to 
cause the death of my son, who is so very dear to me, by 
refusing to give up your wife to him?" "Would you, 
yourself, my lord, under similar circumstances," replied 
the physician, "be willing to give up Stratonice to the 
Prince, if it had been she with whom he had fallen in love ? ' ' 
Seleucus having already vowed that he would not hesitate 
for a moment to do so, Erasistratus declared the whole 
truth to him, and of course there was nothing left for the 



ERASISTRATU8 AND HEROPHILUS 107 

King but to keep his word. History fails to state whether 
or not the lady made any objection to the transfer. As 
Antiochus lived to reign for many years after the murder 
of his father, it is safe to assume that he recovered his 
health. 

This brief tale, the truth of which is not disputed by any 
of the authorities, reveals Erasistratus to have been a 
clever diagnostician, to have possessed a profound knowl- 
edge of human nature, and to have been a man of excep- 
tional courage; in short, he was a physician admirably 
fitted to act as the founder and leader of one of the two 
great medical schools of Alexandria. The following 
account may suffice to convey some idea of his career after 
he became established at the latter city. 

At the beginning of his residence in Alexandria, 
Erasistratus, like his great rival Herophilus, devoted his 
energies to anatomical and physiological researches. 
These two men evidently realized to the full how important 
it was to medicine, if it were to make a substantial advance 
beyond the point to which Hippocrates and his followers 
had already carried it, that a more complete understanding 
of the structure and working of the human body should be 
obtained; and their efforts in this direction were greatly 
aided by the enlightened views of the kings of Egypt, the 
Ptolemies, who did everything in their power to furnish 
these two investigators with all the human dissecting 
material they could use to advantage. They even went so 
far as to allow them the privilege of utilizing, for scientific 
purposes, the living bodies of imprisoned criminals, ''in 
order that they might in this way learn the location, color, 
shape, size, construction, hardness, softness, smoothness, 
nature of external surface, protuberances and recesses of 
the individual organs during life." The defense which 
they offered for permitting such vivisections was this: 
"It is permissible to sacrifice the lives of a few criminals 
if many worthy persons may thereby be permanently 
benefited in health, or have their lives prolonged." 
(Puschmann.) Those who were opposed to such exami- 
nations upon human beings expressed their disapproval in 



108 GROWTH OF MEDICINE 

the following terms: **TMs practice is not only cruel, but 
useless, and at the same time it derogates from the dignity 
of the healing art, which is intended to be a blessing and 
not a source of pain to man; for those in whom the 
abdominal cavity is first opened and then the diaphragm 
divided, die before it is possible to make the scientific 
examination ' during life ' which constitutes, as it is claimed, 
the justification for the entire procedure." (Puschmann.) 
As regards the work done by Erasistratus in the depart- 
ments of anatomy and physiology, the following statement 
may be made: He threw a great deal of additional light 
upon the structure of the lacteals, the valves of the heart, 
the brain, the nerves, and several other portions of the 
body ; and he assigned to the pneuma, or breath,^of which 
he assumed that two kinds exist, — the most important role 
in the mechanism of life. According to the description 
given by Galen and reported by Le Clerc, the phenomena 
to which Erasistratus refers take place somewhat as 
follows: ''When the thorax or chest expands, the lungs 
also undergo dilatation and fill themselves with air. This 
air, entering first by way of the trachea, ultimately reaches 
the anastomosing terminals of the bronchial tubes, from 
which locality the heart, by the act of dilatation, draws it 
into itself, and then, immediately afterward contracting, 
sends it, by way of the great artery (the Aorta), to every 
part of the body." When it is considered that at this 
remote period of time nothing was known about oxygen 
and carbon dioxide, nor about the power of these elements 
to pass freely through a thin membrane (exosmosis and 
endosmosis), no surprise will be felt that Erasistratus 
carried the physiology of respiration no farther than he 
did. On the contrary, it is remarkable that he was able to 
describe so correctly this complicated process. In fact, 
none of his successors, up to the time when Harvey's great 
discovery was announced, was able to furnish a better 
description. The physiology of gastric digestion was 
another of the problems concerning which Erasistratus 
held views that were different from those commonly 
accepted by the physicians of that time. The stomach, he 



ERASISTRATUS AND HEROPHILUS 109 

maintained, first retracts when portions of food are 
introduced and then contracts in such a manner as to break 
them up into smaller and smaller fragments ; this process 
taking the place of that of *'coction," as taught by Hip- 
pocrates. The resulting chyle passes from the stomach 
into the liver and is deposited in those spots where the 
finer branches of the vena cava and the terminal twigs of 
the channels which lead into the gall-bladder come together. 
Here the chyle breaks up into two portions, one of which — 
viz., that which contains biliary elements — gains an 
entrance into the channels that lead to the gall-bladder, 
while the other, which is composed of elements suitable 
for making pure blood, finds its way into the ramifications 
of the vena cava. While holding these views about the 
mode of transformation of gastric chyle into the bile and 
pure blood, Erasistratus did not hesitate to confess that 
he was unable to say whether bile was produced within 
the body or whether it already existed in the food that was 
taken into the stomach. 

As regards the treatment of disease Erasistratus held 
certain views which were decidedly at variance with those 
maintained by the majority of his associates. Thus, for 
example, Straton, a distinguished disciple of this master, 
praises him for having banished bloodletting from the list 
of remedial measures, and adds that he can testify to the 
fact that Erasistratus had, by other means, cured all the 
diseases in which the ancients commonly employed blood- 
letting as the chief remedial agent. His favorite substitutes 
for the latter procedure were fasting, dieting, physical 
exercise, and — in cases of hemorrhage — placing ligatures 
around the arms and legs. Caelius Aurelianus is authority 
for the statement that, in certain very exceptional cases, 
Erasistratus did resort to bloodletting. Another of the 
latter 's tenets was his strong objection to the employment 
of purgatives and composite remedies. On the other hand, 
he appears to have attached considerable importance to 
the employment of chicory in the treatment of all disorders 
of the abdominal organs. One of the eividences of his 
preference for this drug is to be found in the care which 



no GROWTH OF MEDICINE 

he takes in describing how the plant should be prepared for 
remedial purposes. "Boil a bunch of the plant in water 
until the mass is thoroughly cooked; then cast it into a 
fresh supply of boiling water (to drive out still more of its 
bitter quality) ; and finally, upon removing it from the 
boiling water, place it for conservation in a receptacle 
containing oil. When it is required for use add a small 
quantity of weak vinegar. ' ' Galen, in commenting jocosely 
upon the stress which Erasistratus lays upon these details, 
makes the remark: ''As if our domestics did not know 
how to cook a bunch of chicory ! ' ' 

Speaking of the effects produced by venom when one is 
bitten by a poisonous snake, Erasistratus remarks that 
''from the effects which the poison introduced in this 
manner produces, we may derive a general indication as 
to how a cure may be obtained. The poison, it will be noted, 
destroys very quickly the parts with which it comes in 
contact, and then, by spreading throughout the body, 
causes death. The thing to do, therefore, is to draw it as 
quickly as possible out of the body and thus arrest its 
further spread. To this end the wound should first be 
enlarged and its sides scarified; then, after it has been 
sucked, a cupping glass should be applied over it; and, 
finally, it should be cauterized." 

Erasistratus cultivated surgery as well as the other 
branches of medicine. He was a bold operator, as may be 
inferred from the fact that, in cases of scirrhus or other 
variety of tumor of the liver, he did not hesitate to incise 
the skin and overlying integuments, and then, after the 
peritoneal cavity had been opened, to apply directly to the 
seat of the disease such medicaments as seemed to him 
appropriate. On the other hand, he did not approve of 
paracentesis abdominis in cases of dropsical effusion, as a 
means of evacuating the fluid accumulated in the peritoneal 
cavity. 

It appears that the disciples and successors of Herophilus 
and Erasistratus soon abandoned the exact methods which 
these two great masters had inaugurated and which, in a 
comparatively short time, had produced such admirable 



ERASISTRATUS AND HEROPHILUS 111 

results, and then they fell back into the less arduous, the 
easy-going ways of speculation. Only a very few had 
sufficient strength of character to walk in the older path- 
way, and among the number were some who left Alexandria 
and established schools in the other cities — as, for example, 
Zeuxis, who organized a new centre of medical teaching at 
Laodicea, in the interior of Asia Minor, and Hikesios, who 
founded another school at Smyrna, on the seacoast of 
Lydia. It is not strange, therefore, that before many years 
had elapsed the two original schools at Alexandria died a 
natural death. As Pliny aptly writes, **It was so much 
more comfortable to sit on the benches of the schools and 
have learning poured into your ears than to wander daily 
through the desert outside in search of other nourishing 
plants. " As a further result of this deadness of the schools 
at Alexandria (that is, of the sect of the Dogmatics) the 
more serious-minded physicians espoused with eagerness 
the side of the Empirics — a sect which developed about this 
time, but which did not, it must be confessed, hold out much 
hope of solving the physiological and pathological problems 
of the day, but which nevertheless satisfied in some measure 
their needs as practitioners. 

Philinus of Cos (286 B. C.) was looked upon as the 
founder of the school of the Empirics, and among its most 
distinguished disciples were: Serapion of Alexandria 
(279 B. C), Glaucias, Apollonius Biblas, and — perhaps the 
most celebrated of them all — Herakleides of Tarentum 
(242 B. C), who did such excellent work in the department 
of pharmacology. It was he, for example, who defined 
more precisely than had been done by any one of his 
predecessors the proper manner of employing opium. In 
addition, he wrote a commentary on the Hippocratic 
works and also separate treatises on medical, surgical and 
pharmaceutical topics. In the latter category belongs his 
book entitled **A Military Pharmacopoeia." Last of all, 
Apollonius Mus, a distinguished follower of Herophilus, 
deserves to be mentioned because it was he who perfected 
the preparation of castor oil. At a still later date (158 
B. C.) Zopyrus proved himself to be a most worthy sue- 



112 GROWTH OF MEDICINE 

cesser to Herakleides. It was he who first classified drugs 
according to the effects which they produce, and he also 
invented or discovered the preparation named ''ambrosia," 
a general antidote for poisons of all kinds. Kings and 
princes were, at that period, in constant fear of being 
poisoned, and so it came about that those who were skilled 
in the knowledge and preparation of drugs were greatly 
stimulated by their royal patrons to find efficient antidotes. 
It is narrated that Attains Philometer, King of Pergamum, 
the native city of the famous physician Galen, and Mithri- 
dates Eupator, King of Pontus, cultivated poisonous plants 
in their gardens and tried the effects of the poisons distilled 
from them on criminals. They also encouraged in every 
possible way the preparation of antidotes; and thus was 
compounded a mixture which even to-day is still known by 
the name of ^^Mithridaticum." For centuries it was a very 
popular remedy for poisoning by snake-bite. Le Clerc 
states that one of the first things that the great Roman 
general Pompey did, after conquering Mithridates and 
gaining possession of his palace (about 64 B. C), was to 
have a careful search made for the recipe of this famous 
antidote. Upon finding it he was surprised to learn what 
simple ingredients it was composed of — viz., ''20 leaves 
of rue, a pinch of salt, two nuts, and two dried figs. ' ' The 
theriacum, which one hundred years later was modeled 
after the Mithridaticum, contained a great deal of honey 
and a large number of unimportant drugs, introduced — as 
Pliny claims — "to magnify the importance of the apothe- 
cary's art, rather than to increase the curative effects of 
the remedy." 

The scepticism which already at that period had begun 
to take possession of many of the best minds manifested 
itself in the form of a disbelief in the possibility of 
discovering full scientific truth, and men therefore taught 
the doctrine that the human understanding is not capable 
of attaining anything higher than probability. The accept- 
ance of such a doctrine naturally acted as a powerful 
hindrance to all further original research. And so the 
Empirics neglected the study of anatomy and physiology 



ERASISTRATUS AND EEROPHILUS 113 

as something quite superfluous and unprofitable. They 
gave no further thought to the causes of disease, and were 
quite satisfied simply to observe its manifestations, to 
investigate the factors which appeared to bring it into a 
state of activity, and to search for the means of eifecting 
a cure. In carrying on work of this character, they of 
course derived help, not only from their own experience, 
but also from that of others — which latter became in time 
a matter of history. When they encountered new expe- 
riences and were unable to supply a satisfactory expla- 
nation they resorted to a third method — that of reasoning 
by analogy. Upon this triple support — one's own indi- 
vidual experience, the experience of others stored up in 
the form of history, and reasoning by analog}^ — rested the 
entire structure of empiricism. 

Strange as it may at first appear, the science of medicine 
from this time onward made no further conspicuous 
progress until the middle of the seventeenth century of the 
present era. In certain branches of practical medicine — 
as, for example, pharmacology, obstetrics and general 
surgery, and also in certain special departments — the 
Empirics made a number of material additions to our 
knowledge; but in all essential particulars the toiedical 
science taught throughout this period of about two thou- 
sand years varied but little from that taught at Alexandria 
one hundred or two hundred years before the birth of 
Christ. This extraordinary phenomenon of almost com- 
plete arrest of development for so long a period of time 
should not excite surprise, for something of a similar 
nature has certainly occurred in other departments of 
human knowledge. 

The further history of the medical sects which flourished 
under the Ptolemies and for a short time afterward, when 
Alexandria became a colony of the Roman Empire, need 
not detain us long. Daremberg furnishes a chronological 
chart of the physicians who played a more or less prominent 
part in the work of these sects, and from this it appears 
that they numbered thirty-four in all — ten followers of 
Herophilus, fourteen of Erasistratus, and ten Empirics. 



114 GROWTH OF MEDICINE 

Callamachur and Bacchius, who belonged to the first of 
these groups, deserve to be mentioned because they were 
its most distinguished members and because they were the 
first physicians who wrote commentaries on the writings 
of Hippocrates. In the sect of the Empirics the next in 
importance after Philinus of Cos is Serapion of Alex- 
andria. Mantias, another disciple of Herophilus, gained 
considerable reputation from the fact that he was the first 
to collect together into a single treatise the different 
pharmaceutical formulae that were then in general use. 
He was also an authoritative writer on surgical topics. 

Certain Branches of Medical Work Begin to Assume 
more Distinctly the Character of Specialties.- — At the time 
of Hippocrates there were no specialists, or at least none 
who received any sort of official recognition from the 
general body of physicians ; and yet, there were, even then, 
a few practitioners who devoted themselves preferably to 
the treatment of certain maladies, like the affections of the 
eye and the teeth; and, beside these, there were undoubt- 
edly, in the larger communities, men who were ready and 
competent to undertake the more serious surgical opera- 
tions. But even these men, as appears from the language 
of the so-called Hippocratic oath, could not honorably 
perform an operation for stone in the bladder; this 
particular work having been left from time immemorial 
entirely in the hands of the lithotomists, a class of men 
who performed no other kind of surgery and who, in 
fact, were considered outside the pale of the medical 
profession — ^merely surgical artisans. 

During the Alexandrian period the attitude of the best 
physicians with reference to specialization in medical 
practice evidently underwent a change, — not a very marked 
one, it is true, but yet sufficient in degree to attract some 
attention. We read, for example, that a certain Demetrius 
of Apamea, a follower of Herophilus, was skilled as an 
obstetrician and was also a clever diagnostician; that 
Andreas of Carystus, another disciple of Herophilus and 
the physician upon whose authority the incredible story 
of the burning of the Cnidian archives by Hippocrates was 



ERASISTRATUS AND HEROPHILUS 115 

spread abroad, was considered at this time an expert in the 
science of obstetrics; that, toward the end of the period 
(first century B. C), Alexander Philalethes, a disciple of 
Herophilus and well known as an author of treatises on the 
pulse and on the doctrines taught by different physicians 
of that period, acquired widespread celebrity as a gynae- 
cologist; that Straton, a disciple of Erasistratus, had 
gained considerable distinction as a gynaecologist; and, 
finally, that two physicians — Gains of Naples and Demos- 
thenes of Marseilles (Massilia) — were widely celebrated 
for their skilfulness in the treatment of eye diseases. The 
latter was also a successful author, for his treatise on 
ophthalmology retained its popularity down to the Middle 
Ages. All these men, it should be noted, were directly and 
indirectly connected with the work at Alexandria, and were 
physicians of some degree of prominence. It is fair to 
assume, therefore, that specialization in medical practice 
had by this time become an accepted fact and was certainly 
not frowned upon by those in authority. The result is 
entirely in accord with what might be expected from a body 
of physicians as enlightened as were the men gathered 
together at Alexandria during the centuries immediately 
preceding and that immediately following the birth of 
Christ; but many additional centuries were yet to elapse 
before anything like the well-defined specialism of modern 
times was to become an established fact. 



CHAPTER XI 

ASCLEPIADES, THE INTRODUCER OF GREEK 
MEDICINE INTO ROME 

The seventh Ptolemy, Ptolemy Euergetes or Physcon, 
whose reign lasted from 146 to 117 B. C, drove all men of 
learning away from Alexandria and closed the famous 
schools in that city. It was only a few years after these 
events, and at a time when that city was fast losing its 
supremacy as the great centre of medical learning,^ that 
there appeared at Rome a Greek philosopher and physician 
who was destined to become the founder of a new set of 
medical ideas and of a new kind of medical practice. Being 

1 After Alexandria first came under Eoman rule (about 30 B. C.) member- 
ship in the Museum was granted to athletes and other men of no education, 
and it is said that even before that time Ptolemy Euergetes, who had reopened 
the schools during the latter part of his reign, bestowed some of the important 
positions upon men who were simply his favorites. The library of the Museum 
was seriously damaged by fire at the time when Julius Caesar was being 
besieged in Alexandria by the inhabitants of that city, and was at last wholly 
destroyed by Amrou, the Lieutenant of the Caliph Omar, in A. D. 651. The 
truth of this extraordinary tale regarding the burning of books belonging to 
the library at Alexandria in the seventh century is seriously doubted by 
Sismondi (Histoire de la Chute de I'Empire Bomain, Vol. II., p. 57). "It 
was," he says, "published for the first time, by Abulpharagius, about six 
centuries after the event is supposed to have occurred. And yet the con- 
temporaneous national historians, Entychius and Elmacin, make no mention 
of it whatever. An act of this nature, furthermore, would be in direct conflict 
with the precepts of the Koran and with the profound respect which the 
Mohammedans habitually entertain for every scrap of paper on which the 
name of God happens to be written," 

Under the later rule of the Eomans, Alexandria regained a good deal of 
its literary importance and also became a chief seat of Christianity and 
theological learning; but as a centre of medical influence its glory had long 
since departed. 



ASCLEPIADES 117 

a man of general cultivation and attractive personality, 
and not afraid to encounter the prejudices and ill will which 
almost always greet a foreigner when he first establishes 
himself in a strange country and among a people of a 
different race, he soon overcame those obstacles and was 
eventually successful in making Rome the starting-point 
and centre of the best medical thought and practice of that 
period of the world's history. To understand clearly, 
however, the character of the work which Asclepiades 
accomplished in the city which was soon to be the capital 
of the world as then known, it is desirable that a brief 
account should be given of the condition of medical affairs 
in Rome at the time of his arrival. 

The Practice of Medicine at Rome During the Century 
Immediately Preceding the Christian Era. — Foreigners 
were not encouraged to settle in Rome until toward the 
latter part of the second century B. C, and consequently 
the treatment of the sick in that city maintained its 
distinctly Roman character for an unusually long time. 
In the households of the better classes the head of the 
family commonly prescribed for any illness which might 
befall its members. In not a few instances one of the 
slaves — who was known as a servus medicus, and who 
might perfectly well have been a regularly educated Greek 
physician — took charge of the patient in place of the.^ 
master of the house. A book of domestic remedies was the 
usual source of information from which the latter derived 
his knowledge of therapeutics. Marcus Porcius Cato, the 
distinguished Roman censor (234-149 B. C), was the 
author of one of the most popular of Jkese books of recipes. 
The text of this work has come down to our time. There 
were, at this period, no regularly established physicians 
and no such thing as a medical practice. For several 
hundred years the Romans were almost constantly at war 
with the neighboring tribes or nations, and this life of 
outdoor exposure and active exercise kept them free from 
the numerous and very varied bodily ills of the later 
generations. This state of society alone was quite sufficient 
to prevent the thoroughly trained physicians of Greece and 



118 GROWTH OF MEDICINE 

Alexandria from settling in Rome. But there were still 
other forces at work which greatly delayed their taking 
such a step, viz., the unwillingness on the part of the 
authorities to grant to foreigners the rights of citizenship, 
and the very strong prejudice which the Roman aristocracy 
cherished with regard to the Greek nation. Some idea of 
the strength of the latter feeling may be gathered from the 
letter which Cato the Censor, perhaps the most influential 
citizen of Rome at that time, wrote to his son Marcus. 
Daremberg gives the following quotation from this epistle : 
' * The Greeks are a perverse and unteachable race. Believe 
that an oracle is speaking to you when I say — Every time 
that the Greeks bring to us some branch of knowledge they 
will not fail to corrupt our manners; and it will be far 
worse for us if they should send us their physicians, for 
they have bound themselves by an oath to kill all Bar- 
barians by the aid of medicine — and they have the insolence 
to reckon us also as Barbarians. Remember that I have 
forbidden you to call in a physician." Daremberg adds: 
**The old man Cato must have been very simple-minded 
to believe for a moment that physicians would be such 
egregious fools as willingly to kill the patients from whom 
they derive their support. ' ' But even this strong prejudice 
on the part of the Roman aristocracy had to give way in 
course of time to forces of a much stronger character. 
During the second century B. C, the Romans, no longer 
fearing the encroachments of their warlike neighbors and 
having overcome all danger of an invasion on the part of 
their once powerful Carthaginian foe, entered upon a career 
of conquest. The capture of an ever increasing number 
of cities and towns in Greece, Asia Minor, Egypt and 
Africa brought great wealth to Rome, and, with it, increas- 
ing luxury, an increase in the prevalence and variety of 
diseases, and an increased need of men who were competent 
to deal successfully with such diseases. The physicians 
who first attempted to meet this need were men of an 
inferior stamp, to whom the situation appeared simply to 
afford an excellent opportunity for making money; and 
very naturally they failed to gain the respect and confidence 



ASCLEPIADES 119 

of the better citizens. At a later date Julius Caesar, who 
was, at that time, Consul (about 90 B. C), extended the 
right of citizenship to all foreign physicians who were 
practicing in Rome, and thus was removed one of the 
greatest obstacles which prevented the better class of Greek 
medical men from settling in that city. 

More than a hundred years before the time of which I 
am speaking {i.e., about 218 B. C), a Greek physician 
named Archagathus had the courage to take up his abode 
in Rome. He was the son of Lysanias, a native of Pelo- 
ponnesus. At first he appeared to gain the favor of the 
community in which he practiced, for they bought and 
placed at his disposal a shop, or office, in the cross-way of 
Acilius, and gave him the name of vulnerarius — healer of 
wounds. Later, however, they disliked his rather too free 
use of the knife and the actual cautery, and thereafter he 
was spoken of as the carnifex, or executioner. Medicine 
was thus brought into disrepute and we hear nothing 
further about physicians in Rome for more than a cen- 
tury — that is, until about 90 B. C, when Asclepiades,^ a 
native of the city of Prusa, Bithynia (northwest part of 
Asia Minor), made his appearance in that city. At first he 
taught rhetoric, but, finding this occupation unprofitable, 
he began the practice of medicine. Pliny says that he 
acquired a knowledge of this art through the studies which 
he carried on after his arrival in the city of Rome, but 
Neuburger makes the statement that he began the study 
of rhetoric, philosophy and medicine in his youth and then 
spent some time in perfecting his knowledge at Parion, a 
city of Mysia on the Hellespont, at Athens, and probably 
also at Alexandria. 

As a practitioner Asclepiades appears to have met with 
unusual success. He was well educated and possessed of 
agreeable manners, and was the friend as well as the 
physician of Cicero, one of the most polished men of whom 
history furnishes us any knowledge. He was also on terms 
of intimacy with Atticus and other eminent citizens of 

2 Asclepiades was not a descendant of Aesculapius, as one would naturally 
infer from the name which he bore. 



120 GROWTH OF MEDICINE 

Rome. The possession of such friends was more than 
sufficient to render him one of the favored and prosperous 
physicians of his day in that city. As Meyer-Steineg aptly 
says, *'he owed not a little of his success to the happy 
manner in which the scientist, the clever physician, and — 
to a slight degree — the charlatan were combined in his 
character." The following anecdote which is told of him 
by Lucius Apuleius shows, on the one hand, that he 
possessed remarkably keen powers of observation, and, 
on the other, that there were some grounds for the 
charge that his behavior was at times somewhat theatrical 
in character: — 

One day, as Asclepiades w?is returning to the city, from his 
place in the country, he observed the approach of a long 
funeral procession. Desiring to learn whether the deceased was 
a person of his acquaintance, and also in the hope of perhaps 
gaining other information of a professional nature, he approached 
as nearly as possible to the bier. The face of the corpse was 
anointed with sweet-smelling ointments over which spices had 
been sprinkled; but, notwithstanding this, he was able to detect 
certain signs which led him to suspect that the man might not 
yet be dead; and accordingly he examined the body very closely 
and thus satisfied himself that such was indeed the fact. Where- 
upon he called aloud that the man was still alive, and told the 
bearers to extinguish the torches, to carry away the materials for 
the pyre, and to remove the funeral feast from the grave to a table. 
Some at once objected to the carrying out of these measures and 
made sarcastic remarks about the healing art — probably because 
they were already in possession of the man's estate, and were afraid 
that they might have to give it up. The more influential ones, 
however, insisted that the physician's words should be heeded. 
Then Asclepiades, notwithstanding the opposition which was made 
by the relatives, succeeded in securing a brief delay, during which 
he had the supposed corpse removed to his own house. Restorative 
measures were employed, respiration was re-established, and the 
man was brought back to life. At the succeeding festivities 
unlimited praise was bestowed upon the wise physician. 

Whether this tale, which I have copied from Neuburger, 
is true or not, it seems to fit in well with the bold and 



ASCLEPIADES 121 

independent character of Asclepiades as it is revealed to 
us by the different writers of the history of medicine. In 
his comment upon this narrative the distinguished Viennese 
historian makes the remark that Asclepiades was very 
conceited, and — like most reformers — showed a disposition 
to ignore the work accomplished by his predecessors. He 
also expresses the belief that Asclepiades possessed a 
leaning toward the methods of the charlatan; the episode 
just narrated revealing a love for theatrical display in his 
professional activity. On the other hand, in the further 
course of the chapter which he devotes to this famous 
Eoman physician, Neuburger gives fuller recognition to 
the value of the services which he rendered to medicine, 
and thus, in the light of these services, one is justified in 
overlooking any little weaknesses of character which he 
may have displayed. Perhaps the most important of the 
services which Asclepiades rendered was that of having 
introduced Greek medicine into Rome — an important con- 
necting link in the transmission of medical knowledge from 
Greece to Modern Europe. 

The Views of Asclepiades with Regard to Physiology 
and Pathology. — The human body, according to the 
philosophy of Asclepiades, is composed of atoms — that is, 
small bodies which are invisible, have no definable quality, 
are in continual motion, through mutual pressure undergo 
modifications in form, and break up into innumerable 
smaller fragments or particles that differ both in size and 
in shape. The arrangement of these small bodies is such 
that intercommunicating spaces or pores are left between 
them, and through these channels flows a sap or juice 
containing larger and smaller particles; the larger ones 
composed of blood, and the smaller of vapor or heat. 
Health, according to Asclepiades, is that state in which the 
primitive atoms are properly distributed or placed and the 
flow of the juices in the pores takes place normally. When, 
however, the flow is arrested and the primitive atoms are 
disordered in their relations to each other and to the pores, 
or when the elements composing the fluid contents of the 
latter become mixed, disease results. Alterations in the 



122 GROWTH OF MEDICINE 

pores themselves, as contradistinguished from the fluid 
contained within them, may also cause disease. Farther 
on, when the proper time arrives for considering the sect 
of the Methodists, I shall have occasion to discuss this 
subject again, and particularly that part of it which relates 
to pathology. In the meantime, however, I cannot resist 
the impulse to say a few words about the remarkable 
insight possessed by Asclepiades into the manner of 
construction of the human body, as manifested by this very 
brief but very significant anatomical and physiological 
description. Upon a first reading one might easily get the 
impression that Asclepiades has reference to only one kind 
or system of *' pores" or channels — viz., such as serve for 
the circulation of tissue juices alone. But, upon a closer 
scrutiny of the text, one finds some warrant for suspecting 
that he had in mind more than one system of such channels ; 
for he states distinctly that the fluid circulating in these 
pores contains larger particles composed of blood and 
smaller ones which consist of vapor {spiritus) or heat. 
The question suggests itself: Could a man who had no 
knowledge of Harvey's discovery, who did not possess a 
microscope, and who at the same time believed — as did all 
the ancients — that air circulated in the arteries and blood 
in the veins, come any nearer to the actual truth than did 
Asclepiades? His description needs very few alterations 
and additions to make it fit correctly the system of terminal 
arterio-venous channels known to-day as arterioles and 
capillaries. 

Methods of Treatment Adopted by Asclepiades. — The 
prevailing methods of treating diseases in Rome were not 
approved by Asclepiades, and he lost no opportunity of 
giving expression to this disapproval. In the first place, 
he protested vigorously against the practice of prescribing 
on every possible occasion purgatives and remedies capable 
of producing vomiting. He had a decided preference for 
gentler measures, his idea being that a physician should 
cure his patients tuto, celeriter, et jucunde — safely, quickly 
and agreeably. Le Clerc adds that this is a fine sentiment, 
but that its realization in actual practice is something 



ASCLEPIADES 123 

which most physicians find it very difficult to attain. 
Asclepiades condemned strongly the employment of 
magical remedies, a practice which was still much in use 
at that time in Rome, although it was already less common 
than it had previously been. Cato 's collection of household 
remedies contains a short list of some of these appeals to 
man's superstition.^ In addition to the remedial measures 
mentioned above, Asclepiades placed his chief dependence 
on the following: abstinence from meat; the employment 
of wine under certain well-defined circumstances ; massage 
and frictions; baths of different kinds (it is said that he 
devised a great variety); walking; driving and being 
carried about in the open air in a litter or in a boat on a 
quiet river or in the protected harbor. One of his remedies 
in the case of sleeplessness consisted in having the patient 
placed in a suspended couch which could easily be rocked 
from side to side. As all these measures were agreeable 
and could at the same time easily be employed by almost 
everybody, they met with general favor, and in consequence 
Asclepiades was looked upon by the Romans as '*a person 
sent from heaven." As a rule, he recommended the 
drinking of simple water, but in certain cases (to be 
mentioned farther on) he did not hesitate to advise the 
taking of wine in moderation. He advocated tracheotomy, 
in cases of inflammation of the throat, in preference to the 
then prevailing practice — both very painful and quite 
difficult to carry out — of introducing a tube of some kind 
as a means of opening a passage for the entrance of air 
into the lungs. 

Le Clerc quotes Galen as authority for the statement that 
Asclepiades, who never hesitated for an instant to criticise 
the different therapeutic procedures of his predecessors, 

8 It would not be easy to fix, even approximately, the date when remedies 
of this character ceased to find acceptance in the popular mind of Europeans, 
but there can be no doubt that they were employed rather frequently even 
as late as during the eighteenth century; — indeed, measures that strongly 
smack of superstition are now and then looked upon with favor by the well- 
educated members of our modern society. For many centuries, however, they 
have been abandoned by all physicians excepting those who are unworthy to 
bear that honored title. 



124 GROWTH OF MEDICINE 

did not go so far as to condemn wholly the practice of 
bloodletting. Indeed, he was quite ready to employ it in 
the treatment of painful affections because, as he claimed, 
the pain was caused ''by the retention of the larger 
particles or atoms in the pores or channels of the tissues, 
and hence — as these particles were composed of blood — 
bloodletting was the only remedy capable of setting them 
free." Thus, he resorted to bleeding in pleurisy, because 
this affection is characterized by pain; but he abstained 
from employing the remedy in ''peripneumonia" or 
"inflammation of the lung," because in most cases it is 
not accompanied by pain; and he also did not approve of 
its employment in inflammation of the brain {phrenitis). 
On the other hand, he advocated bleeding in epilepsy and 
all forms of disease in which convulsions occurred, and he 
also advocated it in cases of hemorrhage of every descrip- 
tion. Quinsy sore throat was another malady in which he 
drew blood freely from the veins of the arm, of the temple 
and even of the tongue ; and in addition, when the disease 
was severe, he scarified the skin at suitable spots and 
applied cups to the part. In all these measures his purpose 
was "to open the pores"; and when this treatment failed 
he incised the tonsils or the uvula, and even, as a last 
resort, performed laryngotomy or tracheotomy. In cases 
of dropsy he employed paracentesis abdominis, — that is, 
he made a very small opening in the abdominal wall to 
serve as an outlet for the fluid contained in the peritoneal 
cavity. From these facts it is evident that Asclepiades did 
not always abide by his rule not to use any but very gentle 
remedies. 

Asclepiades showed, in his manner of treating still other 
pathological conditions, how different was his practice from 
that of his predecessors. In the first place, he was very 
partial, as has already been stated, to such extremely mild 
forms of physical exercise in the open air as one can obtain 
from driving or from being carried in a litter or a boat. 
He prescribed these measures, not merely for convalescents 
but also for those, for example, who were still in the midst 
of an active fever. His idea was, that by means of such 



ASCLEPIADES 125 

very gentle forms of exercise the pores would become less 
clogged and would permit the juices of the body to flow 
more freely. In cases of dropsy, also, he was in the habit 
of employing friction for precisely the same purpose. He 
even used this remedy in cases of inflammation of the brain, 
in the expectation that he might thereby induce sleep for 
these patients. Indeed, this subject of frictions was one 
on which Asclepiades wrote at greater length than on any 
other remedial agent. 

It is a surprising fact that, in common with Erasistratus, 
he taught the doctrine that physical exercise was not at all 
necessary to persons in normal health. At the same time 
he approved of it, when carefully graded, for those who 
were affected with bodily ills of a certain nature. 

Wine was another remedy which Asclepiades was fond 
of prescribing in all sorts of maladies, but his rules in 
regard to the manner in which it should be employed were 
quite different from those adopted by his contemporaries. 
A few illustrations will suffice to show the different 
conditions for which he was wont to advocate the taking 
of wine : He gave it, for example, — though probably much 
diluted with water — to patients affected with fever, but 
only after the stage of greatest activity had been passed. 
Strange as it may appear to-day, he was rather in favor 
of giving to patients ill with inflammation of the brain 
(phrenitis) wine in sufficient quantity to produce intoxi- 
cation; his belief being that he could in this way induce 
drowsiness and eventually sleep) — a thing so desirable for 
those affected with that disease. Further, he instructed 
sufferers from catarrh to drink twice or three times as 
much wine as they usually drank, in consequence of which 
instructions the patients found it necessary to dilute their 
wine with water to a less degree than usual — that is, to 
such a degree that the proportion would be one-half of 
each; thus showing, as Le Clerc remarks, how sober the 
ancients must have been when they were in perfect health. 
They probably — he adds — drank their wine ordinarily in 
the proportion of five-sixths water to one-sixth wine, or, 
at most, three-quarters water to one-quarter wine. 



126 GROWTH OF MEDICINE 

In some cases Asclepiades prescribed the drinking of 
wine (particularly the wine of Cos) to which sea-water had 
been added; his idea being that the addition of salt would 
enable the wine to penetrate farther into the tissues and 
thus open the pores more freely. This idea of added salt 
was not original with him, for Pliny states that in certain 
parts of Oreece it was customary to place casks filled with 
new wine in the sea and to leave them there for some 
time. The wine, it was claimed, was rendered by this 
procedure mature and pleasanter to drink. They called 
wine thus treated ''Thalassite wine" (from the Greek word 
'^thalassa," sea). In cases of jaundice he occasionally 
recommended the drinking of plain sea-water, whereby the 
bowels were stimulated to act more freely. Under ordinary 
circumstances he employed, for the relief of constipation, 
clysters, but he was sparing in their use. 

The remedial measures enumerated above, together with 
dieting, are those upon which Asclepiades chiefly relied in 
his practice. In acute diseases he made very little use of 
drugs that were to be taken internally, but in maladies 
of a chronic character he employed them quite freely. 
Gargles, poultices and inunctions are mentioned among the 
external remedies which he often prescribed. 

Further Particulars Regarding the Life and Career of 
Asclepiades. — Le Clerc furnishes a number of details which 
throw additional light upon the career of Asclepiades. 
During the latter 's lifetime his professional reputation was 
very great. Lucius Apuleius, the famous Eoman satirist 
and rhetorician, and a contemporary of Asclepiades, calls 
him the Prince of Physicians, second only to Hippocrates 
the Great; Scribonius Largus, a Roman physician and 
writer, who flourished during the reigns of the Roman 
emperors Tiberius and Claudius (37-54 A. D.), speaks of 
him as a great medical author ; Sextus Empiricus, a writer 
remarkable for his learning and acumen, who lived in the 
first half of the third century A. D., calls him a physician 
of unrivaled skill; and Celsus, who is termed the Cicero 
of physicians, on account of the purity of his Latin, holds 
him in high esteem as a medical authority. His fame as a 



ASCLEPIADES 127 

physician had spread to Asia Minor, for we are told that 
Mithridates, King of Pontus, who reigned from 120 B. C. 
to 63 B. C, and who was a man of great ability and great 
energy, invited him to take up his residence at his court; 
but Asclepiades refused. Perhaps a still stronger evidence 
of his real worth as a man is to be found in the fact that 
he was the physician and personal friend of Cicero. 

Notwithstanding these strongly favorable estimates of 
the ability of Asclepiades there were not a few men, and 
they too men of great authority, who were indisposed to 
give him so conspicuous a place in the temple of fame. 
Galen, for example, while admitting that he was a very 
eloquent physician, maintained that he was a sophist, given 
to quibbling, and disposed to contradict everybody. 
Caelius Aurelianus, a contemporary of Galen and the 
author of the most important practical treatise on Metho- 
dism that has come dowTi to our time, appears to have held 
the same opinion as Galen with regard to Asclepiades. 
The complete disappearance of all the writings of the latter 
author makes it impossible for us at the present time to 
form an independent judgment as to the merits of these 
conflicting estimates of the man's character. Galen was 
a great admirer of Hippocrates and it is very likely that 
he took offense at the failure of Asclepiades to accept all 
the teachings and therapeutic methods of his hero. As to 
the reasons which led Caelius Aurelianus to agree with the 
estimate made by Galen, we know absolutely nothing. 

Toward the middle of the seventeenth century there was 
discovered at Rome, not far from the Capena gate, a 
portrait bust in white marble of Asclepiades. It was 
probably executed by a Greek sculptor residing in Rome, 
for, if the work had been done in Greece, the face would 
have been represented with a beard, as are the heads of 
Hippocrates, Soranus and other celebrated physicians of 
antiquity. The absence of the beard, furthermore, shows — 
according to the opinion of antiquarian experts — that the 
bust must have been sculptured before the time of the 
Emperor Claudius (41-54 A. D.), as he was the first of the 
Caesars to wear a beard. This bust, which is a little larger 



/■ 



128 GROWTH OF MEDICINE 

than life size, is at present — if I am rightly informed — 
in the Capitoline Museum at Rome. 

Asclepiades lived to a great age. In descending, one 
day, a flight of steps he fell and received injuries from 
which he died. 



CHAPTER XII 

THE STATE OF MEDICINE AT ROME AFTER THE 
DEATH OF ASCLEPIADES; THE FOUNDING OF 
THE SCHOOL OF THE METHODISTS 

In summing up the effects which were produced by the 
teaching and practice of Asclepiades upon the science and 
art of medicine, Dr. Meyer-Steineg makes the remark that 
the wide and ready acceptance of both depended largely 
upon the personal character of the man, upon the manner 
in which he carried out the measures which he advocated, 
and upon the fact that the Romans happened at that period 
of their history to be ready to respond favorably to such 
new doctrines and therapeutic methods; but that, as soon 
as his strong personality had ceased to exert its influence, 
as it did after he had passed the active period of his life, 
and also because Rome did not at that moment possess any 
physicians who were sufficiently endowed with his medical 
gifts and sagacity to perpetuate his art, both it and his 
doctrines began to lose ground. Nevertheless, as this 
writer states, Asclepiades had already succeeded admirably 
in preparing the way for a further development of the 
healing art, and for this valuable service full credit should 
be given him. 

Not long after the death of Asclepiades, Antonius Musa,^ 
the personal physician of the Emperor Augustus, suc- 
ceeded, by means of hydrotherapy, in curing his royal 
patient of a protracted gouty or rheumatic affection from 
which he had been a sufferer ; and, as a mark of gratitude 
for the cure which he had effected, the Emperor raised him 

1 Neither Haller nor Dezeimeris furnishes any biographical information 
with regard to Musa. 



130 GROWTH OF MEDICINE 

to the rank of a noble (about the year 10 A. D.), erected 
a statue in his honor in the temple of Aesculapius, and at 
the same time issued a decree that from that time forward 
the physicians who practiced in Eome should be exempted 
from taxation and from certain other civic burdens. These 
privileges, which were afterward confirmed by Vespasian 
(70-79 A. D.) and also by Antoninus Pius (138-161 A. D.),' 
were of great advantage to the medical profession as a 
whole. Julius Caesar (100-44 B. C), it will be remembered, 
had already (about half a century earlier) bestowed 
Roman Citizenship upon the physicians who practiced 
their profession in that city. Thus, at the time of which 
we are now speaking, the medical men of Rome occupied 
the enviable position of being on an equality with their 
fellow citizens of the better class, a position which made 
it attractive for young men of ability and of good social 
standing to enter the profession. 

Among the numerous followers of Asclepiades the most 
distinguished was undoubtedly Themison of Laodicea, a 
city of Phrygia, Asia Minor, who flourished about the 
middle of the first century B. C. When he was well 
advanced in years he wrote a medical treatise in which 
he developed a system of pathology and therapeutics that 
was accepted as the professional creed of the sect known 
as *' Methodists. " Starting from the doctrine of pores and 
primitive atoms taught by Asclepiades, he laid great stress 
upon the idea that in disease all the alterations which 
take place in the tissues may be classed in one or the other 
of these two categories — a relaxation ^iJaa;2*m) or a con- 
traction (strictum) of the parts. To these two categories, 
which the Methodists termed ** communities, " and which 
were the only ones at first accepted as a part of their creed, 
a third was soon added, viz., that condition in which both 
relaxed and contracted states appear side by side, although 

not necessarily both of them developed to the same degree ; 

« 

2 Antoninus Pius, however, established the rule that these privileges were 
not to be granted to all physicians indiscriminately, but only to a limited 
number; and, later still, it was decided that only the parish physicians were 
entitled to receive them. 



TEE STATE OF MEDICINE AT ROME 131 

and to this third category or *' community" they applied 
the term ^^mixtum." The ideas which are here stated in 
a somewhat crude and imperfect manner owing to my lack 
of knowledge of all the facts, constitute the basis of the 
pathology of the ''Methodists" — a pathology which held 
its own in the domain of medicine during a period of four 
hundred years, and which — in contradistinction to the 
humoral pathology of Hippocrates — is justly entitled to 
the name of ''solidist pathology." This doctrine, as might 
be expected, underwent certain modifications during this 
long period of time, but they were not serious enough to 
alter materially the fundamental form of the teaching as 
it has here been described. 

Themison and his followers, like their distinguished 
predecessor, Asclepiades, possessed something more than 
a mere glimmering of the truth in pathology as we know 
it to-day; and this idea suggests the further thought that 
Morgagni, Rokitansky, Lebert, Virchow and perhaps others 
whose names do not now occur to me, could scarcely have 
developed a better pathology if they had lived during these 
first centuries of the Christian era — a period of time when 
public sentiment did not permit postmortem examinations, 
when Harvey's discovery was not even dreamed of, when 
the microscope was unknown, and when experimental 
pathology was an impossibility. Many centuries had still 
to elapse before medicine could gain that freedom of action, 
that rich equipment of tools, and that stock of accumulated 
knowledge which enable her in these days to make such 
giant strides forward as we have witnessed during the past 
twenty or thirty years. 

The question will naturally arise. How did the Metho- 
dists decide, in the presence of an actual case of illness, 
which one of these abnormal states (the laxum, the strictum, 
or the mixtum) was the condition that called for medical 
treatment? The answer which they gave to this question 
was, that the condition of the different secretions and the 
dejections furnished the principal indication as to what 
particular part or organ of the body was ailing, and also 
as to what was the nature of the morbid change or process 



132 GROWTH OF MEDICINE 

that produced the malady. When, for example, the secre- 
tion from an organ or part was excessive, they inferred 
that the pores of such a part were relaxed and distended, 
thus permitting an increased flow; and when the secretion 
was less than it should be, they decided that the pores were 
contracted. The status mixtus had reference to those cases 
in which a condition of relaxation was observed in one part 
of the body, while that of contraction was noted in another. 

Neuburger mentions the fact that the Methodists were 
somewhat arbitrary in their classification of the different 
diseases, most of the acute maladies being placed by them 
under the heading Status strictus, while they assigned the 
majority of the chronic affections to the category of Status 
laxus. 

The effect of the tendency of the Methodists to classify 
and simplify all the departments of medicine was not 
wholly beneficial. It conveyed to many the impression that 
medicine might readily be learned in the course of a few 
months, and thus offered the temptation to inferior 
men to choose the career of physician; and yet, on the 
other hand, it infused into the art the essentially Eoman 
characteristics of orderliness, simplicity and efficiency. 
Anatomy, for example, was studied only so far as a knowl- 
edge of this department of medicine was necessary to 
render the physician familiar with the location, general 
character and relations of the different organs. There was 
one field, however, in which the adherents of this school 
displayed a high degree of excellence, viz., in their descrip- 
tions of disease ; and this is especially true of those written 
by Caelius Aurelianus (fourth century A. D.), whose 
manner of handling the subject of differential diagnosis is 
far more thorough and satisfactory than that of any of the 
medical authors who preceded him. 

In their treatment of disease, the Methodists were largely 
guided by the principle of contraria contrariis, — i.e., in 
those cases in which, to the best of their belief, a status 
laxus existed, they administered astringents, in the hope 
of thereby bringing the parts back more nearly to a 
contracted condition; and, vice versa, when the diagnosis 



THE STATE OF MEDICINE AT ROME 133 

of status strictus was made, they gave a relaxing medicine. 
The terms *' laxatives" and '* astringents, " which are still 
applied to many drugs, were originated by the Methodists. 
Bloodletting, for example, was one of the remedies which 
they used for producing relaxation, and an astringent was 
employed when a contrary effect was desired. In the list 
of relaxing remedial agents (aside from bloodletting) were 
placed the following: warm baths, poultices, inunctions 
with warm oil, vapor baths, fasting and a restricted diet, 
diuretics (very carefully watched and employed only in 
exceptional cases), emetics, diaphoretics and laxatives. 
The following agents, on the other hand, were classed as 
contracting, astringent and tonic remedies: washing with 
cold water, cold baths, the application of cloths dipped in 
cold water, living in cold air, strengthening diet, wine, 
vinegar, alum, narcotics, etc. Themison, it should be 
added, is the first one among the ancient writers to mention 
the use of leeches as a means of extracting blood. It does 
not follow from this, however, that he was the discoverer 
of this method of local bloodletting ; for it is highly probable 
that this procedure had been in common use for many years 
previous to his time. 

Themison, as I have before stated, was an old man when 
he laid the foundations for Methodism, and it is not 
probable that it attained much importance as a sect until 
several years after his death. Then Thessalus, a native 
of Tralles, a flourishing commercial city of Asia Minor, 
and a man who had received his medical training in one of 
the Greek schools, materially added to the body of doctrines 
held by this sect, and at the same time rendered them more 
acceptable to physicians generally. He was of humble 
birth, the son of a wool carder, and his education had been 
rather neglected ; but he nevertheless managed, by his own 
efforts and in no small' degree by the unlimited self- 
confidence (Galen calls it impudence) which he possessed, 
to push his way to the top of the ladder.' He acquired a 

8 It seems almost unnecessary to call attention to the fact that the subject 
of these remarks is not to be confounded with Thessalus, the son of 
Hippocrates. 



134 GROWTH OF MEDICINE 

large fortune during the reign of Nero (54-68 A. D.) and 
apparently succeeded in persuading this monarch that he 
was a great physician. Here are some facts which appear 
to justify Galen's dislike for Thessalus: In a letter to 
Nero the latter writes: **I have founded a new medical 
sect, the only genuine one in existence. I was forced to do 
so because the physicians who preceded me had failed to 
discover anything that is likely to promote health or to 
drive away disease ; even Hippocrates himself having laid 
down doctrines which are positively harmful." His vanity, 
according to Le Clerc, reached such a pitch that he called 
himself the *' conqueror of physicians."* Pliny corrobo- 
rates the latter statement in the following words : ''When 
he assumed the title of 'conqueror of physicians,' a title 
which was engraved, according to his instructions, on 
his tomb in the Appian Way." Notwithstanding his 
unbounded conceit, Thessalus appears to have made several 
important improvements in the doctrines of the Methodists. 
He is also, as it appears, entitled to the credit of having 
been the first to inaugurate the practice of giving sys- 
tematic instruction at the bedside ; thus establishing for all 
time a most valuable precedent for the guidance of his 
successors. 

"He was an excellent practitioner and an original thinker. 

He was also a prolific writer, as is shown by the number 

and variety of treatises which — as we are assured by Caelius 
Aurelianus — were composed by him." The same authority speaks 
of him as "a leader among our chiefs," thus affording good evi- 
dence of the degree of esteem in which he was held by the members 
of his own school. The fact that pupils came in throngs to be 
taught by him shows clearly how thoroughly he understood the 
needs of the physicians of Rome. (Meyer-Steineg.) 

Thessalus, notwithstanding his declaration that medicine 
might readily be taught in six months, wrote a larger 
number of treatises on professional topics than any student 
of medicine could possibly read and digest in the course of 

* larpovlKfis is the word employed in the original Greek. 



THE STATE OF MEDICINE AT ROME 135 

two or three years. They filled several large volumes, but 
not one of them is known to exist to-day. He wrote at great 
length, as we are assured, on the subject of surgery, a 
subject in which he took an active interest. He taught that 
ulcers, no matter in what part of the body they may be 
located, require the same kind of treatment. 

If an ulcer is excavated, it is necessary to bring about a filling-up 
of the excavation ; if its surface is on a level with the surrounding 
skin, the aim should be to make it cicatrize ; if the growth of new 
tissue is excessive, the redundant portion should be destroyed by 
burning with caustic ; and, finally, if the ulcer is of recent develop- 
ment and bleeds readily, the attempt should be made, by approxi- 
mating the edges, to effect an immediate healing. 

In the treatment of chronic ulcers which show little or 
no disposition to heal, and which, when they do finally heal, 
are very prone to break open afresh, Thessalus urges the 
great importance of ascertaining, if possible, the cause or 
causes of this behavior. If it be found that the trouble is 
due to some weakness or abnormal predisposition of the 
part in which the ulcer is located, or that the condition of 
the entire body is probably the real cause of the trouble, 
he recommends the employment of ''metasyncritic reme- 
dies" — that is, remedial measures which effect a marked 
change in the individual's vital processes throughout the 
body, and also such as exert an alterative effect upon the 
ulcer itself. Among the measures of the first class he 
enumerates the following: Various forms of physical 
exercise; alternately increasing and diminishing the 
amount of nourishment taken; and perhaps the taking 
of an emetic at the very commencement of the treatment. 
As to the second class of measures — those needed to bring 
about a change in the ulcer itself — he makes the following 
recommendations : Remove from the diseased tissues as 
much as will restore the parts, as nearly as possible, to the 
condition of a healthy wound, and then adopt the treatment 
suited for the latter condition. In cases in which the ulcer 
heals and then subsequently breaks open again, it will 



^ 



136 GROWTH OF MEDICINE 

sometimes be found beneficial to apply in the neighborhood 
a plaster containing an irritating substance like mustard, 
the effect of which is often to change the disposition of the 
parts. In actual practice he recommends that the local 
measures should be employed first, and then, if they fail 
to accomplish the desired purpose, the physician should 
have recourse to those enumerated in the first class — the 
strictly metasyncritic remedies. 

It is rather difficult to believe that a man so full of 
conceit and so unjust in his criticisms of his predecessors 
as Thessalus clearly was, could be capable of formulating 
such a concise statement of the nature of chronic ulcers 
and such a practical rule for their proper treatment. His 
development of the idea of ' ' metasyncrisis " — or renovation 
of the body (recorporatio), as Caelius Aurelianus trans- 
lates the word — seems to have been original with Thes- 
salus.^ The Methodists, it should be added, deserve special 
credit for having been the first to introduce and carry into 
eifect the systematic treatment of chronic diseases; and, 
as a general proposition, it may be said that their treatment 
of all forms of disease was thoroughly practical, free from 
all tendency to resort to magical methods, and based largely 
on the employment of such hygienic measures as the use 
of baths of different kinds (hydrotherapy), massage, 
moderate outdoor exercise, passive movements, sea 
voyages, fasting, regulation of the diet, etc. One of the 
favorite practices — of which Thessalus was said to have 
been the originator — was to begin the treatment of almost 
all maladies by prescribing an abstinence from all food for 
a period of three full days. When I come to speak of 
Soranus and Caelius Aurelianus I shall probably have 
occasion to give further details regarding the methods of 
treatment employed by the Methodists. 

As a system, says Neuburger, Methodism was not capable 
of inaugurating any fundamental advances in medicine; 
the most that it was able to accomplish was to broaden and 

5 The word ' ' metasyncrisis, " as we are assured by Le Clerc, was employed 
first by Cassius, one of the earlier disciples of Methodism, and then, long after 
the time of Thessalus, by Galen, Oribasius, Aetius and Paulus Aegineta. 



THE STATE OF MEDICINE AT ROME 137 

otherwise improve the domain of therapeutics, and some 
of its wiser members were diligent in collecting and sifting 
critically a large number of valuable experiences, which 
were then courteously registered by them to the credit of 
the sect. 



CHAPTER XIII 

THE FURTHER HISTORY OF METHODISM AT 
ROME, AND THE DEVELOPMENT OF TWO NEW 
SECTS, VIZ., THE PNEUMATISTS AND THE 
ECLECTICS.— A GENERAL SURVEY OF THE 
SUBJECT OF SECTS IN MEDICINE 

Among the Methodists there were many physicians who 
attained more or less distinction during their professional 
career, but only two of them, beside those whose contri- 
butions to medical knowledge have already been mentioned 
in these pages, gained sufficient celebrity to justify me in 
devoting some additional space to the description of the 
work which they accomplished. Soranus, of Ephesus on 
the coast of Asia Minor, and Caelius Aurelianus, of Sicca 
in the north of Africa, are the physicians to whom I have 
reference. 

It was Soranus, says Le Clerc, who gave the finishing 
touches to the system of the Methodists, and the work 
which he did was of such excellence that he may with 
justice be called the ablest and most skilful of all the 
members of that school. Caelius calls him ' ' a chief among 
the leaders of our sect. ' ' He received his medical training 
at Alexandria and came to Rome about the year 100 A. D. 
His professional career covered the period corresponding 
to the reigns of Trajan and Hadrian (98-138 A. D.). He 
is known to posterity chiefly through his two treatises — 
one on obstetrics and gynaecology and the other on acute 
and chronic diseases. The first of these treatises, in the 
original Greek, was rediscovered in 1838 by Reinhold 
Dietz, Professor of Medicine in the University of Konigs- 



HISTORY OF METHODISM AT ROME 139 

berg, Prussia, and a German translation of the work (by 
Liineberg and Huber) was published in Munich in 1894. 
Moschion, who was probably a pupil of Soranus, wrote a 
popular treatise on the same subject for the use of mid- 
wives, and in this book he has reproduced much of the 
material which is to be found in the work of his master. 
The treatise written by Caelius Aurelianus on acute and 
chronic diseases is admitted by him to be founded on that 
which Soranus wrote on the same subject. In fact, as 
Daremberg states, the work of the former represents 
almost a translation (into Latin) of Soranus' treatise. 
The sources just named are the principal ones from which 
our knowledge of this author is derived. 

Soranus was a prolific writer; the treatises which he 
wrote and which deal with a great variety of subjects, 
number thirty in all. The majority of these works, how- 
ever, have been lost. He had many followers and his 
influence upon medical science was very great, not simply 
during his lifetime, but also for several centuries after his 
death. He commanded the respect and confidence of the 
opponents of Methodism as well as of the members of his 
own sect. One of his most pronounced traits of character 
was his readiness to condemn, on every possible occasion, 
superstitious practices, such as the employment of amulets, 
magnets, etc. He was also a very persistent and earnest 
advocate of the gentler and more rational obstetric methods. 
For example, he disapproved of the reckless employment 
of remedies for hastening the expulsion of the foetus, of 
the practice of succussion (which was carried out by the 
aid of a ladder), of making the pregnant woman run up 
and down stairs, of a resort to rough mechanical procedures 
for extracting the placenta, etc. The following quotation 
from one of Soranus' treatises ( Gynaeciorum, Lib. L, 
cap. 19) reveals clearly what sort of a man and physician 
he was : — 

There is a disagreement; for some reject destructive practices, 
calling to witness Hippocrates, who says, "I will give nothing 
whatever destructive" and deeming it the special province of 
medicine to guard and preserve what nature generates. Another 



140 GROWTH OF MEDICINE 

party maintains the same view, but makes this distinction, viz. : 
that the fruit of conception is not to be destroyed at will because 
of adultery or of care for beauty, but is to be destroyed to avert 
danger impending at parturition, if the uterus be small and cannot 
subserve the perfecting of the fruit, or have hard swellings and 
cracks at its mouth, or if some similar condition prevail. This 
party says the same thing about preventing conception, and with 
it I agree. 

(Translated from the Greek by the late John G. Curtis, M.D., 
of New York.) 

Soranus was not only a great obstetrician, — admitted 
by all the authorities to have been the greatest in ancient 
times, — he was also in high repute for the work which he 
did in other departments of medicine — in gynaecology, 
for example, in the instruction of midwives, in the manage- 
ment of children's diseases, in the diagnosis and treatment 
of both acute and chronic diseases, in surgery, etc. While 
in general he adhered to the fundamental teachings of 
the Methodists, he did not hesitate to depart from the 
beaten pathway of that sect in his explanations of certain 
pathological conditions; for he was more of a clinical 
observer than a sectarian, and it was probably his inde- 
pendent manner of thinking that gave the sect new vigor 
and thus enabled it to live on through such a long period 
of time. Galen, who was not at all disposed to speak 
favorably of the Methodists, says that he tried a number 
of the remedies recommended by Soranus and found them 
good. 

Caelius Aurelianus probably flourished during the third 
century A. D. The different authorities, however, do not 
agree as to the limits of the period during which he lived; 
some saying that his career antedated that of Galen, while 
others claim that he came upon the scene after the death 
of the latter, which occurred early in the third century 
A. D. His chief merit appears to have been that, through 
his translation of the writings of Soranus into Latin, he 
placed within reach of the physicians of Rome the teachings 
of that admirable diagnostician and therapeutist; for it 
must be remembered that the great majority of the Roman 



HISTORY OF METHODISM AT ROME 141 

medical men were not able to read Greek. On the other 
hand, Caelins Aurelianus, who was himself a thoroughly 
practical physician, deserves considerable credit for having 
enriched the text of his book with many very appropriate 
examples (chiefly with regard to questions of diagnosis) 
drawn from his own personal experience, which must have 
been extensive. During the Middle Ages, as we are 
informed by Friedlaender, this work furnished the chief 
source from which the monks derived their knowledge about 
diseases and their proper treatment. The Latin in which 
the book is written is described by nearly all the authorities 
as barbaric. 

The Pneumatists. — Methodism had been established only 
a very few years when Athenaeus of Attalia, a city on the 
coast of Pamphylia, Asia Minor, founded (about 50 A. D.) 
a new sect — that of * * Pneumatism. " He was not the dis- 
coverer of the *'pneuma" or '* vital spirit," for that had 
already been admitted by the earlier schools of philosophy 
as a fifth primary creative element, supplementary to the 
four well-known substances — fire, air, earth and water. 
He believed that heat, cold, moisture and dryness (the 
primary qualities of these four bodies) were not the 
veritable elements of living beings. Heat and cold, he 
maintained, were ** efficient causes" and moisture and 
dryness '* material causes." To these he added ''spirit" 
as a fifth element ; and he taught that this spirit enters into 
the formation of all bodies and preserves them in what 
may be termed their natural state. It was from the Stoics, 
more particularly, that Athenaeus borrowed this belief, 
and it was the latter fact, as Le Clerc says, which led Galen 
to speak of Chrysippus — one of the most famous of the 
Stoics — as ''the Father of the Sect of the Pneumatists." 

In his application of the doctrine of Pneumatism to the 
science of medicine, Athenaeus maintained that the 
majority of diseases owed their origin to some disturbance 
or disorder of the spirit; but it is almost impossible to 
understand, from the scanty data which have come down 
to us, what Athenaeus really meant by the term "spirit," 
and by the expression "disorder of the spirit." 



142 GROWTH OF MEDICINE 

From the definition which he gives of the word ** pulse" one is 
justified in drawing the conclusion that he considered the spirit 
to be an actual substance, capable of undergoing, to a greater or 
less degree, such changes as expansion and contraction. The same 
obscurity of meaning is encountered when one endeavors to dis- 
cover how the new doctrine affected the practice of medicine. 
(Le Clerc.) 

In view of all these circumstances it is not at all sur- 
prising that Pneumatism was not very popular with the 
physicians of Rome, and that, after a brief period had 
elapsed, many of the adherents of this doctrine abandoned 
it and gave their preference to the more practical teachings 
of the Methodists. Meyer-Steineg goes so far as to remark 
that, to all intents and purposes, such a thing as a sect of 
Pneumatists did not exist. 

The most prominent of the disciples of Athenaeus were 
Theodorus, Agathinus, Herodotus, Magnus and Archigenes. 

Haller speaks of Theodorus as the inventor of a remedy 
which, as he claimed, cures all cases of poisoning. 

The Eclectics. — Agathinus, a native of Sparta, was 
the teacher of Herodotus and Archigenes. His chief 
distinction is to be found in the fact that he gave to the 
offshoot from the school of the Pneumatists the name of 
"Eclectics,"^ his object being, as we are assured by 
Neuburger, to bring the three sects (Pneumatists, Empirics 
and Methodists) into closer union. 

Herodotus — who, it is perhaps desirable to state, is a 
different person from the famous historical writer of the 
same name — lived during the latter part of the first century 
A. D., and was more closely allied to the Methodists than 
to the Pneumatists. It appears from the text of a fragment 
of one of his treatises that he wrote a description of the 
disease now called small-pox and directed attention to its 
contagious character. 

Magnus, a native of Ephesus in Asia Minor, is reported 

1 Le Clerc calls attention to the incorrectness — etymologically speaking — of 
the use of the word "Eclectics" in connection with a school or sect. The 
members of such a body are not, he says, "the chosen ones" as the term 
signifies, but "the choosers." 



HISTORY OF METHODISM AT ROME 143 

to have been the writer of a collection of letters on medical 
topics and also of a history of the discoveries made in 
medicine subsequently to the time of Themison. 

Archigenes, the fifth member of this group of Pneu- 
matists, was born in Apamea, Syria, and lived in Rome 
under the reigns of Trajan (98-117 A. D.) and Hadrian 
(117-138 A. D.). Le Clerc speaks of him as belonging to 
the Eclectics rather than to the Pneumatists. This is a 
matter, however, of small importance, as the sects were, 
at that period, very much mixed. The poet Juvenal, who 
was a contemporary of Archigenes, refers to him briefly 
as a physician who had a large practice ; and the historian 
Suidas says that he wrote a great deal about physics as 
well as about medicine. That he was esteemed highly as 
an authority in practical surgery is shown by the fact that 
Galen, when he discusses surgical topics, makes frequent 
quotations from the writings of Archigenes. Only frag- 
ments of the latter, however, have come down to our time. 
His popularity as a practitioner was very great; notwith- 
standing which he managed to write several treatises on a 
variety of topics — on the pulse, on feverish diseases, on 
the different types of fevers, on local affections, on the 
diagnosis and treatment of acute and chronic maladies, 
on the right moment when surgical operations should be 
performed, on drugs, and on therapeutic procedures in 
general. He applied ligatures to blood-vessels and also 
arrested further bleeding from them by passing needles 
through the adjacent parts in such a manner as to exert 
pressure upon the vessel (a procedure which is termed 
** acupressure ") ; he operated for the removal of both 
mammary and uterine cancers; he employed the red-hot 
cautery iron for the arrest of hemorrhage and also for the 
relief of coxalgia, and he was familiar with the use of the 
vaginal speculum. 

Antyllus, another prominent surgeon of that period, 
joined the Methodists at a considerably later date. He 
was also the author of an excellent treatise on surgery, the 
greater part of which, unfortunately, has been lost or 
destroyed. 



144 GROWTH OF MEDICINE 

Aretaeus of Cappadocia, a district of Asia Minor, lived 
during the second century A. D. He was a man of very- 
broad culture. From the fact that he assigned an important 
role to the pneuma, he is usually classed among the 
Pneumatists. He does not appear, however, to have taken 
a very active interest in the doctrines of that school, and 
both Le Clerc and Daremberg seem disposed to call him 
an Eclectic, and we may therefore rank him as one of the 
independent physicians of that period. It is doubtful 
whether he ever practiced in Rome. His two treatises — 
one on the causes and means of identifying acute and 
chronic diseases, and the other on the treatment of these 
diseases — are written in Greek, and are characterized by 
the clearness and simplicity of his descriptions, which very 
closely resemble those of Hippocrates, and by the soundness 
of the advice which he gives in regard to the methods of 
treatment.^ In his conceptions of what a physician should 
aim to be, Aretaeus maintained a very high standard. 
Some of his views regarding human physiology and 
pathology are given here very briefly: Respiration serves 
the purpose of cooling the warmth of the heart, and the 
lungs are therefore prompted by the latter organ to draw 
cool air into their cavities; digestion takes place not only 
in the stomach but also in the intestinal canal, and owes its 
origin to warmth; the cerebral nerves, close to the spot 
from which they originate, cross from one side to the other, 
and by the aid of this fact paralysis on one side of the body 
may be explained. Aretaeus has gained considerable fame, 
says Puschmann, from his description of the ''Syriac 
ulcer," the picture of which he draws agreeing perfectly 
with what is known to-day as pharyngeal diphtheria. In 
various places throughout his writings he displays a 
thorough knowledge of normal anatomy — as, for example, 
when he describes the ramifications of the vena portae and 
gall-ducts of the liver. He was also well informed in 
matters belonging to the domain of pathology, for he gives 

2 Boerhaave, the famous clinician of Leyden, Holland (eighteenth century), 
was instrumental in having an excellent Latin translation made of this work; 
and in 1858 a German translation by A. Mann was published in Halle. 



HISTORY OF METHODISM AT ROME 145 

admirable descriptions of many of the diseases — for 
example, pleurisy with empyema, pneumonia, pulmonary 
consumption, cerebral apoplexy, paraplegia, tetanus, 
epilepsy, diabetes mellitus, gout, etc. From the character 
of these descriptions one is strongly tempted to believe 
that he must have made a certain number of postmortem 
examinations. 

According to Neuburger, Aretaeus enters very fully into 
details when he discusses the subject of diagnosis; his 
statements in one place warranting the belief that he even 
auscultated the heart. His methods of treatment were 
based largely upon his own experience and were generally 
of a simple character. He attached great importance, for 
example, to a very careful regulation of the diet, muscular 
exercise, massage, etc., and his employment of remedies 
was confined to a very small number of such drugs as exert 
a mild action. When the case, however, was of such a 
character as to call for more vigorous interference, he did 
not hesitate to resort to the use of opium, emetics, 
cathartics, venesection, blistering, the red-hot cautery 
iron, etc. 

Rufus, a native of Ephesus, a city of Asia Minor, about 
thirty-five miles from Smyrna, is reckoned by most authori- 
ties among the Eclectics; in other words, he was an 
independent, or one who adopted from the teachings of 
the different sects such doctrines as met with his approval, 
but who, at the same time, did not care to pose as the 
disciple of any one of them. He received his medical 
training at Alexandria, but it is not known where he 
practiced his profession. Almost no details concerning his 
life or his professional career have come down to our time. 
It is simply known that he flourished during the reign of 
the Emperor Trajan (98-117 A. D.). Ebn Ali, an Arabian 
physician and author, says that he was the leading medical 
authority of his time and that his works were highly 
esteemed by Galen. His treatise on anatomy (entitled 
**The Names of the Different Parts of the Human Body"), 
which is one of the few that have escaped destruction, is 
described as a treatise which was written for students, and 



146 GROWTH OF MEDICINE 

which possesses great value for the history of anatomical 
nomenclature. The same authority says that Eufus was 
the first to describe the chiasma, that he came very near 
establishing the existence of two different kinds of nerves — 
motor and sensory — and that he attributed the control of 
all bodily functions to the nervous system. He also states 
that he was one of the first to furnish a description of the 
oriental bubonic plague. Some idea of Eufus' style of 
writing may be gathered from the following quotations 
which have been taken from his short treatise entitled 
**The Questioning of Patients": — ^ 

It is necessary to question the patient, for by so doing one may 
gather more exact information concerning the nature of the malady, 
and will then be able to treat it more intelligently. In this way 
also one may learn whether the patient's mind is in a normal or 
an excited state, and whether any change has taken place in his 
physical strength. Some idea regarding the nature and seat of 
the disease is usually obtained from such questioning. If, for 
example, the patient answers clearly and to the point, and does 
not hesitate ; if his memory does not play him false ; if his speech 
is not thick or indistinct; if, being a well-bred man, he gives his 
responses in a polite and cultivated manner; or if, in the case of 
a person who is naturally timid, the answers reflect this timidity, 
then you may feel confident that your patient 's mind is not affected. 
But if, on the other hand, you ask him about one thing and he gives 
you a reply about something entirely different; if, as he talks, he 
appears to forget what he was talking about ; if he has a trembling 
tongue the movements of which are also uncertain; and, finally, 
if from a certain state of mind he passes rapidly to one of a totally 
different character, — all these changes are evidences that the brain 

is beginning to be affected If the patient speaks distinctly 

and with a fairly strong voice, and is able to tell his story 
without stopping from time to time in order to rest, the 
inference is warranted that his physical strength is not materially 
affected 

The following quotation is from his treatise on gout: — 

If the patient complains that one of his joints is painful, he 
should be asked whether or not the part has received a blow. If 

3 Translated from Oeuvres de Bufus d'£phdse; Edition Grecque et Fran- 
(jaise, par Daremberg et Euelle, Paris, 1879. 



HISTORY OF METHODISM AT ROME 147 

he replies that it has not, then (you may infer that the pain is due 
to gout and) you should forthwith put him on a suitable diet, 
order a clyster and bleed him at a spot not far (from the seat of 

the pain) The withdrawal of nourishment is ordered for 

the purpose of arresting any further formation of new blood and 
thus preventing the joints from growing more sluggish in their 
movements. The clyster is ordered because we believe that it is 
beneficial (in this condition) to evacuate the bowels. The bleeding 
will be found useful, but to a less degree in the loAver than in the 

upper limbs One must be careful not to assume that the 

patient is cured when he has been entirely relieved of his pain, 
because with the lapse of time fresh attacks are liable to occur; 
this disease, like certain other affections, possesses a periodic 
character Therefore it is well, immediately after the blood- 
letting, to employ friction, to get rid of the excess of moisture in 
the body by some laborious form of exercise, to take such articles 
of food as are easily digested, — in brief, to aim chiefly at reducing 
as much as possible the moisture of the body. 

One cannot but feel a keen regret that so few of the 
writings of this thoroughly practical and highly educated 
physician should have come down to our time. So far as 
I am able to learn, Rufus wrote no fewer than 102 
treatises, all of which, with the exception of the seven 
about to be mentioned (together with a number of frag- 
ments preserved by different writers of antiquity) have 
either disappeared or been destroyed. The titles of the 
treatises which have been preserved are as follows: 
(1) Diseases of the Kidneys and Bladder; (2) On Satyriasis 
and Gonorrhoea; (3) Purgatives; (4) The Names of the 
Different Parts of the Human Body; (5) On the Ques- 
tioning of Patients; (6) On the Pulse; (7) On Gout. 

A General Survey of the Subject of Sects in Medicine. — 
During the sixth century B. C, — that is, about two hundred 
years before the formation of the more distinctly medical 
sects of which mention was made in Chapter IX., — 
Pythagoras of Samos and his disciples put forward 
certain beliefs or doctrines with regard to the mode of 
action of some of the functions or vital processes of the 
human body, and all those who accepted these teachings 
as affording a true and satisfactory explanation of the 



148 GROWTH OF MEDICINE 

phenomena in question constituted what is generally 
termed a school or sect. Some of these individuals were 
physicians — that is, men who undertook to cure or at least 
to relieve those who were ill; but probably the majority 
were simply philosophers, mere 'Covers of wisdom," who 
by studying problems of this nature sought to satisfy their 
longing for a more perfect knowledge of the truth respect- 
ing the various phenomena of life. 

A few years later, Heraclitus of Ephesus, who, like 
Pythagoras, was both a philosopher and a practicing 
physician, taught the doctrine that all things owe their 
origin to fire. One is not at all surprised to learn that 
he had relatively few followers, for history tells us that 
he was both a misanthrope and a slanderer of the medical 
profession, as shown by the following saying which is 
attributed to him: ''Next to physicians the grammarians 
are the biggest fools in the world." 

Hippocrates attached much importance to the value of 
experience and to the necessity of studying disease at the 
bedside; at the same time he upheld what is commonly 
known by the name of humoral pathology — a doctrine which 
refers all maladies to some abnormal change in the humors 
or fluid portions of the body. His writings also show that 
he made full use of the reasoning power. The followers 
of this great physician did not form a sect in the ordinary 
sense of the term ; they were his adherents simply because 
he was an able diagnostician, a successful teacher, an 
excellent therapeutist, a skilful surgeon, a man of very 
high moral character, — in short, a great physician. Every 
sect which developed in the centuries following his death 
contained a goodly proportion of Hippocratists. 

Nearly two centuries after the active period of the 
professional life of Hippocrates, Erasistratus and Hero- 
philus gathered about themselves in Alexandria (about 
280 B. C.) large groups of followers, who held for their 
respective teachers a degree of esteem which amounted, 
according to Galen, almost to veneration. As there was 
little or no antagonism or lack of harmony between the 
doctrines taught by these physicians, the two groups can- 



HISTORY OF METHODISM AT ROME 149 

not properly be classified among the sects. In fact, it would 
be more correct to say that Erasistratus and Herophilus 
contributed facts of permanent value to our stock of 
knowledge rather than doctrines which might prove highly 
popular for a few scores of years, but which would prob- 
ably in due course of time be set aside as no longer of value. 

The four most characteristic types of sects in medicine 
were the following: the Dogmatists — or Rationalists, as 
Daremberg calls them in one place ; their great rivals, the 
Empirics; the Methodists; and the Eclectics. The oldest 
sect, the Dogmatists, did not come into prominence until 
after the medical schools at Alexandria had already been 
in operation for a long time. The development of the rival 
sect of the Empirics at this late period brought with it 
endless discussions regarding the merits of their respective 
teachings, and thus both of them gained a degree of promi- 
nence which seems to us moderns to have been out of all 
proportion to the importance of the subject-matters dis- 
cussed. The Dogmatists, says one writer, insisted that it 
is just as necessary to be acquainted with the ''hidden 
causes ' ' of disease as with those which are plainly recogni- 
zable, and that it is only by aid of the reasoning power 
that we gain some knowledge of this class of causes. They 
claimed that, while a knowledge of anatomy is of very 
great service to the surgeon, it usually renders this service 
through the aid of the reasoning power; as when, in the 
performance of a lithotomy, the operator selects the fleshy 
{i.e., vascular) neck of the bladder as the spot in which to 
make the opening with the knife, in preference to the base 
of the organ, which is chiefly membranous in structure and 
therefore less likely to heal solidly. 

The plausible but rather shallow response made by the 
Empirics to the arguments advanced by their rivals con- 
sisted in quoting certain maxims, as, for example : * * The 
farmer and the helmsman do not acquire knowledge of 
their respective occupations from discussions, but from 
actual practice"; **It is not of vital importance to know 
what are the causes of the different diseases, but what 



150 GROWTH OF MEDICINE 

remedies are competent to cure them"; and "Diseases are 
not cured by eloquence, but by remedial agents," 

Among the comments made by Celsus with regard to 
the differences which distinguished the Dogmatists from 
the Empirics we find the following statement: *'The two 
sects employed the same remedies and pursued very much 
the same course of treatment, but their reasonings about 
such matters were different." 

Modern physicians will, at first thought, be disposed to 
wonder how men as clever as many of these physicians 
were could have split up into separate and more or less 
antagonistic sects because of such apparently trivial 
differences of opinion. It must be remembered, however, 
that these men were groping in comparative darkness 
whenever they tried to advance their knowledge of path- 
ology, and that in this imperfect light many things seemed 
of much greater importance than they appeared to be in 
the brighter light of later centuries. It is only fair, there- 
fore, to withhold criticism and to ask ourselves whether 
this strong desire on the part of those men to advance 
their knowledge of pathology — a desire which manifested 
itself in the formation of sects — was not in reality an 
evidence of the great vitality of Greek medicine on Eoman 
soil in those early centuries. 

The remarks made above with regard to the Dogmatists 
and the Empirics apply in a general manner to the sects 
known as the Methodists and the Eclectics, a sufficiently 
full account of which has been given in the preceding 
chapter.* 

4 The term ' * dogmatists ' ' is also employed by some authorities to designate 
those physicians who laid great stress upon the importance of following the 
teachings of Hippocrates and Galen. 



CHAPTER XIV 

WELL-KNOWN MEDICAL AUTHORS OF THE 
EARLY CENTURIES OF THE CHRISTIAN ERA 

There were four men who were not especially identified 
with any of the sects described in the preceding chapters, 
and yet who occupied, as authors of medical treatises, very 
prominent places in the history of medicine of the period 
or epoch which we have just been considering. They are 
Celsus, Scribonius Largus, Pliny the Elder and Dioscori- 
des. These men lived during the first and second centuries 
A. D. and they therefore all belong strictly to the period 
which is designated in our scheme as the fourth epoch. 
I shall give here brief sketches of all of these writers and 
of their works. While Caelius Aurelianus, another impor- 
tant medical author, belonged to a much later period, I shall, 
for reasons of convenience, describe in the same chapter 
with the others the part which he played in the evolution 
of medicine. 

Aulus Cornelius Celsus, called by some the Latin Hip- 
pocrates and by others the Cicero of physicians because 
of the correctness and elegance of his Latin and the clear 
manner in which he puts his thoughts into words, flour- 
ished during the reign of the Emperor Augustus (27 B. C- 
14 A. D. ) . The date and place of his birth are not known, 
but it is generally believed that he was born and received 
his education at Rome. The great work which he wrote 
and upon which he must have been engaged the larger part 
of his lifetime was a sort of cyclopaedia, which bore the 
title ^^Artium libri,'* and in which each department of 
knowledge was represented by a separate treatise. It is 
said that five books were devoted to agriculture, seven to 
rhetoric, eight to medicine, etc. ; but all of these treatises. 



152 GROWTH OF MEDICINE 

excepting those relating to the latter science, have been 
lost or destroyed. It is not certainly known to which of 
the professions Celsus belonged, but the very skilful and 
judicious manner in which he has culled all that is best from 
the medical treatises published before his time, the remark- 
able knowledge of technical details which he displays in 
every part of his own work, and the fine tone of medical 
thought which pervades these eight books, almost compel 
the conclusion that the author was a very clever clinician, 
although probably not a physician who practiced for a 
money reward. In no other published treatise is a more 
perfect picture of the medical practice of antiquity to be 
found than that which Celsus gives us in his work ^^De arte 
medica libri octo." 

It is not an easy matter to select, from a treatise of 
several hundred pages in length, one or two passages of 
such a character that they may be accepted as fairly repre- 
senting the author's manner of dealing with medical and 
surgical questions of practical interest. The two given 
below are translations from Vedrenes' version (Paris, 
1876), and they deal, the one with venesection and the other 
with the proper manner of arresting hemorrhage from a 
wound. Both the passages quoted represent only frag- 
ments, as sufficient space for more extensive extracts is not 
available. 

Book II., Chapter X. — Bloodletting from a Vein. — Incising a 
vein for the purpose of drawing blood from it, is not a new pro- 
cedure ; but it is certainly a new thing to resort to bloodletting in 
almost all diseases. Again, it is an ancient custom to employ 
bloodletting in young subjects and in women who are not preg- 
nant, but it is a new thing to perform this operation on infants 
and aged individuals, and on women approaching the period of 
confinement. It was the idea of the ancients that persons at the 
two extremes of life were not able to support this sort of treatment, 
and they were convinced that a pregnant woman, if subjected to 
the operation of bloodletting, would almost surely be confined 
before the completion of her time. Since then, however, experience 
has shown that there is no fixed rule about this matter, and that 
a physician should preferably regulate his course in accordance 
with observations of a different nature. The determining factor, 



EARLY MEDICAL AUTHORS 153 

for instance, is neither the age nor the pregnant state of the patient, 
but rather the degree of physical strength. In the case of a youth 
who is feeble, or of a delicate woman (aside from the question of 
pregnancy), it would be wrong to draw blood, for it would be 
robbing them of what little strength they possessed. But, in the 
case of a vigorous child, a robust old man, or a pregnant woman 
who is in good health, one need not hesitate to resort to this pro- 
cedure. Nevertheless, there may arise, in connection with the 
operation of venesection, a number of questions which are quite 
likely to puzzle an inexperienced physician and perhaps lead him 
into error. For example, infants and old people possess as a rule 
diminished vigor, and the woman who is about to be confined needs 
all her strength for the period following delivery, both for herself 
and for the nourishing of the child. But the mere fact that one 
must give some thought to questions of this nature and must exer- 
cise prudence does not justify the immediate rejection of a method 
of treatment like that of venesection. For is it not the very essence 
of our art, not merely to consider the factors of age and the 
pregnant state, but also to form an estimate of that other and 
more important factor, viz., the patient 's strength, — be that patient 
an infant, an aged person, or a woman advanced in pregnancy, — 
and then to decide whether it is, or is not, great enough to bear 
the loss of blood? In deciding a question of this kind it will be 
necessary to distinguish between real vigor and obesity, between 
thinness and feebleness, etc. 

Venesection is an easy operation for a physician who has already 
familiarized himself with the manner of performing it, but for one 
who is ignorant of these details it may prove very difficult. It is 
necessary, for example, to bear in mind that the artery and vein 
are united and that they are accompanied by nerves ; and, further, 
that the injuring of the latter will induce spasms and violent pains. 
On the other hand, it must also not be forgotten that an artery 
once opened has no disposition to close, nor does it heal, and that 
sometimes the blood escapes in an impetuous manner. If, per- 
chance, the vein is cut transversely, the edges of the opening con- 
tract and no more blood escapes. Again, if the scalpel is plunged 
into the parts timidly, the skin alone will be divided and the vein 
will not be opened. In some cases this vessel is so hidden from 
sight that the physician may experience difficulty in bringing it 
into view. Thus it will be seen that there are several circumstances 
which may render this operation difficult for an ignorant or inex- 



154 GROWTH OF MEDICINE 

perienced physician. The vein should be incised in a longitudinal 
direction, midway between its two sides. The moment the blood 
gushes from the opening its color and general appearance should 
be carefully noted, etc. 

Book v.. Chapter XXYI. — The Proper Manner of Arresting 
Hemorrhage from a Wound. — If there is fear that there may be 
bleeding, one should fill the wound with dry lint, place over it a 
sponge wrung out of cold water, and press upon it with the hand. 
If the bleeding still continues, it is advisable to change the stuffing 
of lint somewhat frequently; and, if this step proves ineffective, 
then lint moistened with vinegar may be tried, for this liquid 
acts energetically in arresting hemorrhage. Some physicians, in- 
deed, actually pour it into the wound. There is a strong objection, 
however, to the use of an agent which, like vinegar, arrests the 
bleeding too completely — viz., that it is apt to set up afterwards 
an intense inflammation of the parts. The same reasoning applies 
with even greater force to the employment of corrosives and caus- 
tics, which produce an eschar. Despite the effectiveness of most of 
these in arresting hemorrhage, their use should be discouraged. 

Finally, if the bleeding continues it will be necessary to 

grasp the vessel from which the blood is escaping, to ligature it 
in two places close to the wound, and then to divide the vessel 
between the two ligatures, in order that it may retract (both of 
the new orifices having already been closed by the ligatures). If 
the circumstances are such that the plan just recommended can- 
not be carried out, it will then be advisable to apply the red-hot 
cautery to the bleeding vessel. When a rather free hemorrhage 
occurs at a part of the body where there are no nerve trunks and 
no muscles, — as on the forehead or at the top of the head, — the 
simplest plan is to apply a cup at some little distance from the 
source of the bleeding and thus divert the current of the blood 
from the spot affected. 

And to these two longer extracts may be added a third : — 

From these considerations the inference is warranted that a 
physician cannot possibly give proper attention to a large number 
of patients. (Book III., Chapter IV.) 

Celsus' treatise was ignored by physicians for many 
centuries, but it was considered by the monks, in the Mid- 
dle Ages, a valuable guide in the treatment of disease ; and 
it was probably owing to this circumstance, says Vedrenes, 



EARLY MEDICAL AUTHORS 155 

that the book did not altogether disappear. It was not 
until the year 1443 that Thomas de Sazanne, afterward 
Pope Nicholas V., discovered a copy of the work in the 
church of Saint Ambrosius, at Milan, but it was only in 
1478 that the book was printed for the first time (at Flor- 
ence). Then, as if to make up for the long neglect to which 
it had been subjected, no fewer than sixty Latin editions 
were issued during the two succeeding centuries; and, in 
addition, it was eventually translated into every modern 
European language. 

Scribonius Largus, a Roman physician who lived dur- 
ing the reigns of Tiberius and Claudius (14-54 A. D.), owes 
his celebrity to the fact that he wrote and published (in 47 
A. D.) a book containing a collection of the best medical 
formulae and popular recipes known at that time. He ap- 
pears to have had a large private practice and to have 
spent a considerable portion of his professional life in the 
service of the army. He accompanied the Emperor 
Claudius, for example, in his campaign against Britain 
(43 A. D.), and the book which he wrote, and which has just 
been mentioned, was dedicated by him to that emperor. 
According to Neuburger, Scribonius is to be credited with 
having been the first to describe correctly the proper manner 
of obtaining the drug known as opium, and also the first 
to recommend, in the treatment of severe headaches, the 
employment of electric shocks as communicated by the fish 
called the ** electric ray." 

Medical practice at that period, says Le Clerc, was 
divided among three kinds of practitioners — those who 
treated their cases exclusively by dietetic measures, those 
who effected cures by surgical means, and those who took 
charge only of such patients as required chiefly the employ- 
ment of external remedies. But Scribonius Largus insists 
that such a division was more theoretical than real, as 
no one of these classes could get along without the co- 
operation of the others. 

C. Plinius Secundus, commonly called Pliny the Elder, 
was born near the beginning of the first century of the 
Christian era, either at Verona or at Como in the north 



156 GROWTH OF MEDICINE 

of Italy, and settled in Eome at an early period of his life. 
At the beginning of his career he served for some time in 
the army in Germany, and upon his return to Eome prac- 
ticed as a pleader. Subsequently he held various official 
positions which gave him the opportunity of visiting other 
countries of Europe. He perished at Stabiae (near the 
modern Castellamare, on the Gulf of Naples) in 79 A. D., 
at the age of fifty-six years, while watching the eruption of 
Vesuvius, which overwhelmed Herculaneum and Pompeii. 
He was in command of the Roman fleet at the time. 

Pliny was indefatigable as a writer and as a gatherer 
of knowledge of all sorts, and he and Celsus are well named 
the Encyclopaedists. He is said to have written twenty 
books on the war with the Germans, an unknown number 
on rhetoric and grammar, and thirty-seven on natural his- 
tory. The latter books alone have come down to our time. 
Pliny's nephew, who is known as Pliny the Younger, and 
who edited the great work of his uncle on natural history, 
furnishes us, in a letter addressed to the historian Taci- 
tus, with some interesting details regarding the elder 
Pliny's manner of life. It appears from this account, that 
the latter read almost incessantly. During his meals and 
while he was taking his bath, an attendant read aloud to 
him. He also took his books with him on his travels and 
was always accompanied by a person who could write rap- 
idly under dictation. He continued this practice upon his 
return to Rome and dictated to his amanuensis even while 
he was being carried about in a sedan chair. Books 20- 
27 of his great work on natural history are devoted to the 
subject of remedial agents belonging to the vegetable king- 
dom, books 28-32 deal with those which belong to the ani- 
mal kingdom, and books 33-37 treat of mineralogy with 
special reference to medicine, painting and sculpture. 
Pliny was a compiler and not an original investigator. 
Some idea of the popularity of his treatise on natural his- 
tory may be gathered from the fact that it was the second 
book to be printed after the invention of printing, the Bible 
being the first. Another interesting fact connected with 
Pliny's treatise is mentioned by Neuburger, viz., that the 



EARLY MEDICAL AUTHORS 157 

use of hyoscyamus and belladonna as agents capable of 
dilating the pupils, owed its origin to the discovery (by C. 
Himly, in 1800) of a place in the text (Book XXV., 92) 
where it is stated that the juice of the plant Anagallis was 
rubbed into the eyes before the operation for cataract was 
undertaken. 

According to Pliny (Book XXXL, Chapter VI.), the 
ancients employed mineral waters extensively in the form 
of baths, and they also occasionally used them as internal 
remedies. Galen, too, mentions the fact that these waters 
were in demand in the spring or autumn for purgative pur- 
poses. 

In Book XXXIX., 8, 3, Pliny — as quoted by Vedrenes — 
makes the following remarks : — 

Very few Romans have shown an active interest in medical affairs, 
and those few speedily found it necessary to pass themselves off as 
Greeks. For it is a well-known fact that those physicians who, 
without being able to speak Greek, attempted to build up a prac- 
tice in Rome, failed to gain the confidence of their patients, even 

of those who were not at all familiar with that language 

When one's health is the question at issue the readiness to place 
confidence in a medical adviser is apt to diminish in proportion 
as one's knowledge of the man increases. Indeed, medicine is the 
only art in which one is quite ready at first to put faith in almost 
anybody who calls himself a physician, and that too, despite the 
acknowledged fact that in no other circumstances of life is an 
imposture more fraught with danger. 

English versions of Pliny's Natural History and of 
Pliny the Younger 's Letters have been published in what 
is known as Bohn's Libraries. 

Pedanius Dioscorides, a native of Anazarba, a small 
Greek town near Tarsus in Cilicia, lived about the middle 
of the first century A. D. (during the reigns of Nero and 
Vespasian). From his earliest youth he took a great in- 
terest in botany, and, after reaching manhood, traveled 
extensively in the wake of different Roman armies, for 
the sole purpose of studying by direct observation the 
plants of different countries and of verifying the medicinal 
virtues which each one was reputed to possess. In this 



158 GROWTH OF MEDICINE 

way lie visited, in turn, Greece, Italy, Asia Minor and per- 
haps also the southern portion of France (the Narbonaise). 
He collected great quantities of specimens of every kind 
of drug — animal and mineral substances as well as objects 
belonging to the vegetable kingdom; and, wherever it was 
possible to do so, he wrote memoranda of the traditions 
of the natives with regard to the uses and medicinal effects 
of these different drugs. After he had completed all these 
researches and had gathered together all this vast mass of 
materials, he wrote his famous treatise on materia med- 
ica — 'Hhe most complete, the best considered, and the 
most useful work of its kind to be found anywhere to-day." 
(Galen.) It is from this treatise, therefore, says Dezei- 
meris, that one can derive the most satisfactory idea of 
the early Greek materia medica ; but at the same time, he 
adds, it is not a book in which will be found a detailed 
account of the manner in which the practitioners of that 
period employed the remedies which he describes. The 
same authority calls attention to the great difficulty which 
modern physicians often experience in their attempts to 
identify the drugs which Dioscorides describes. Le Clerc 
calls attention to the fact that the physicians who were 
contemporaries of Dioscorides were not in the habit of 
employing either iron or antimony (called by them stibium) 
internally. Apparently they had not yet learned that these 
substances possess properties which exert a curative action 
in certain diseases. On the other hand, he mentions the 
manner of extracting quicksilver, by chemical means, from 
cinnabar [red sulphide of mercury], the steps required 
for preparing acetate of lead, and the proper way of mak- 
ing lime water. 

The work to which reference has been made above was 
published by Dioscorides about the year 77 A. D. It is 
the earliest pharmacological treatise that has come down 
to our time, and for many succeeding centuries it served 
as the authoritative guide in all questions relating to drugs. 
The first printed edition of the Greek original appeared in 
Venice in 1499, but a still earlier Latin version was issued 
in 1478. According to Pagel the best edition (in Latin and 



EARLY MEDICAL AUTHORS 159 

fully illustrated) is that of Pietro Andrea Mattioli, which 
was printed in Venice in 1554. Neuburger commends 
highly the German version by J. Berendes. (Stuttgart, 
1902.) 

Of Caelius Aurelianus we possess no biographical de- 
tails beyond the facts that he was a native of Sicca in 
Numidia, Africa, and that he lived toward the end of the 
fourth or during the first part of the fifth century of the 
present era. He was the author of several works, all but 
one of which, however, have been lost. The single treatise 
which has come down to our time treats of acute and 
chronic diseases, and is spoken of by Daremberg as being 
virtually a translation of one of the lost writings of Sora- 
nus. This book, says Haeser in his History of Medicine, 
is the most important source from which our knowledge 
of Methodism is derived; and Neuburger not only agrees 
with this statement, but adds that the treatise of Caelius 
Aurelianus played a most important part, toward the end 
of the Middle Ages, in the evolution of medicine. Up to 
the present time no translation of this work into any mod- 
ern language has been published, but Neuburger furnishes 
a very full analysis of its important parts. In two places, 
as appears from this analysis, Caelius Aurelianus men- 
tions — among the signs and symptoms of certain affections 
of the respiratory apparatus — phenomena which show 
beyond a doubt that he (or Soranus) was familiar with 
auscultation of the chest. The words which he uses are 
these : — 

''Stridor vel sonitus interius resonans aut sihilans in ea 
parte quae patitur," and '' sihilatus vehemens atque asper 
in ultimo etiam pectoris resonans stridor." 



CHAPTER XV 

CLAUDIUS GALEN 

During the centuries immediately preceding the Chris- 
tian era, Greek medicine was represented by a collection 
of treatises which had been written by Hippocrates and his 
followers on anatomical, physiological, pathological, thera- 
peutical and ethical subjects, and which constituted a fairly 
complete but not always easily intelligible system. As 
time went on, however, and especially as new and useful 
facts were constantly being added to the existing stock of 
medical knowledge, the more thoughtful physicians began 
to feel that the system, which up to that day had proved 
acceptable, needed to be perfected in a number of respects ; 
and accordingly, as a result of this feeling of dissatisfac- 
tion, and also as an expression of the prevailing desire 
for a more perfect knowledge of the truth, there developed, 
as has been stated in the preceding chapters, a number of 
different medical sects. When Galen first appeared in the 
field as a physician of unusual promise, these various sects 
were all still in a thriving condition. The Methodists, in 
particular, were very popular. Galen did not favor any 
special sect, but in his writings he made it manifest that 
he attached more importance to the teachings of Hip- 
pocrates than to those of any other author. ''It was Hip- 
pocrates," he said, ''who laid the real foundations of the 
science of medicine." It is therefore not surprising that 
Galen should have devoted so much time to the writing of 
elaborate commentaries on the works of Hippocrates. The 
service which he thus rendered to medicine, says Darem- 
berg, was of very great value. But Galen, notwithstanding 
his great admiration for Hippocrates, did not hesitate to 



^ 



CLAUDIUS GALEN 161 

criticise a number of his teachings, and especially those 
which, as he believed, were not stated with sufficient clear- 
ness. Valuable as was the service rendered to medicine by 
the writing of these commentaries, there still remained an 
urgent need for a service of a different and much more 
difficult kind, viz., that of welding together into a single 
clearly written and easily intelligible system of medicine, 
all that was good in the Hippocratic writings and in the 
disconnected and at times antagonistic teachings of the 
sects. To accomplish this successfully required the ser- 
vices of a man endowed with mental gifts of a most excep- 
tional character — complete knowledge of medicine in all 
its departments, a mind thoroughly trained in philosophy, 
the power to express his thoughts in simple language, and ijji 

an independence and fairness of judgment which would 
render him indifferent to the petty interests of the sects. 
Claudius Galen, as subsequent events showed, possessed 
these very gifts in a high degree, and he devoted the better 
part of his reasonably long lifetime to the accomplishment 
of this much-needed work. How greatly it was needed at 
that particular period of time, nobody then knew or could 
even suspect. It soon appeared, however, that all the 
vaunted civilization of the Graeco-Roman world — ^much of 
it of the purest gold and a great deal of the basest alloy — 
was to be swept so completely off the face of the earth that, 
for thirteen hundred or more years, almost no thought 
whatever could possibly be given to the science and art of 
medicine. Fortunate, most fortunate it was, therefore, 
that, before this wave of destruction reached Rome, all the 
best part of Greek medical literature — for such it was in 
truth — had been gathered together and carefully systema- 
tized by Galen and stowed away in the recesses and cham- 
bers of remotely situated monasteries and churches by 
clear-sighted monks for the benefit of later generations of 
physicians. 

Brief Biographical Sketch. — Claudius Galen was born 
in Pergamum, an important Greek city of Asia Minor, 
about the year 131 A. D., under the reign of the Emperor 
Hadrian. His father, whose name was Nicon, was a man 



*i 



162 GROWTH OF MEDICINE 

of ample means, well informed in philosophy, astronomy 
and geometry, and most liberal in providing for the thor- 
ough education of his son in every branch of useful knowl- 
edge. In two or three places in his writings Galen speaks 
of his father in terms of affection. On the other hand, he 
does not hesitate to state in the plainest language possible 
that his mother was a veritable Xanthippe. In her mo- 
ments of bad temper she would not only shout and 
scream in a violent manner, but would sometimes go so 
far as to bite her serving-maids. Pergamum, at the time 
of which I am writing, offered unusually good opportu- 
nities for studying disease. Its Asclepieion, which was 
built during Galen's boyhood, had already become one of 
the famous temples of Asia Minor, and the sick and maimed 
flocked to it in large numbers. Then, in addition, the city 
was well equipped with able physicians, who appear, ac- 
cording to Neuburger, to have been on very friendly 
terms with the priests of the temple. It was under the 
guidance of such men that Galen — at the early age of 
seventeen, and after a careful training in philosophy, 
mathematics, etc. — began the study of medicine. He speaks 
with special interest and respect of one of his instructors, 
a certain Quintus, who had the reputation of being an ex- 
cellent anatomist and at the same time one of the most dis- 
tinguished practitioners of that day. Another anatomist, 
Styrus, was also one of Galen's teachers. 

On the death of his father Galen left his home and de- 
voted the succeeding nine years to visiting all the differ- 
ent cities in which he believed he might gain some addi- 
tional knowledge in medicine and surgery. A large part 
of this long period was spent in Alexandria, which still 
retained much of its importance as a home of all the sci- 
ences. On attaining his twenty-eighth year he left that 
city and returned to Pergamum, evidently with the pur- 
pose of establishing himself there in the regular practice 
of his profession. Through the influence of the temple offi- 
cials, and especially of the High Priest, Galen received the 
appointment of physician to the gladiators, a position 
which he held with credit for a period of four years, and 



CLAUDIUS GALEN 163 

which afforded him excellent opportunities for cultivating 
his knowledge of surgery. It was while he was serving 
in this capacity that he devised and put into practice 
a method of saturating the dressings (in cases of severe 
wounds) with red wine, for the purpose of preventing the 
development of inflammation in the parts affected ; and the 
success which he thus obtained was so great that not one 
of the gladiators intrusted to his care died from his 
wounds. History does not state the precise manner in 
which Galen carried out his method of utilizing wine in the 
dressing of wounds, and we are therefore unable to deter- 
mine just how much credit he was entitled to receive for 
this crude but apparently effective means of securing local 
antisepsis. It is clear, however, that Galen's treatment 
could only have been a modification of a much older method, 
for Jesus, in his answer to a question put to him by a 
lawyer, said : * ' But a certain Samaritan, as he journeyed, 
came where he (the injured man) was: and when he saw 
him, he had compassion on him, and went to him, and bound 
up his wounds, pouring in oil and wine, and set him on his 

own beast, " (St. Luke x., 33, 34). 

At the end of four years there broke out in Pergamum a 
riot which rendered residence there, at least for a certain 
length of time, undesirable. Accordingly Galen, who was 
now thirty-two years old, and who was probably glad of an 
excuse for leaving a place where a physician of his educa- 
tion and talents had so few opportunities for gaining dis- 
tinction, decided to visit Rome, and — if circumstances ap- 
peared to favor the plan — to settle there. His first impres- 
sions after arriving in that metropolis were favorable to 
the plan of establishing himself there permanently, but at 
the end of a few years he became conscious of the growing 
hostility of those practitioners who had been for a longer 
time than he well established in that city. This hostility 
increased as he rose in favor and esteem with people of 
position and influence. He had treated skilfully and with 
success Eudemus, a peripatetic philosopher of great celeb- 
rity, for a quartan fever. He had also cured the wife of 
Boethus (a patrician who belonged to the consular class) 



164 GROWTH OF MEDICINE 

of a serious illness and had received as an expression of 
appreciation a gift of four hundred pieces of gold. He 
had won the friendship and esteem of such men as Sergius 
Paulus, the Praetor; of Barbarus, the uncle of the Em- 
peror Lucius; and of Severus, who was at that time 
Consul, but who later became Emperor. These very in- 
fluential men took an active interest in Galen's scientific 
work, having been invited by him on more than one occa- 
sion to witness his dissections of apes, — dissections which 
he made for the particular purpose of demonstrating the 
organs of respiration and of the voice. All these facts soon 
became known to Galen's rivals and probably helped to 
fan the spark of their envy into a flame; but it is very 
doubtful whether he was justified in saying that the ill 
feeling thus engendered threatened to end in some act of 
personal violence, for which reason he decided to leave 
Rome and return to Pergamum. His secret manner of de- 
parture, without taking leave of anybody, and the fact 
that the Plague was just at that time rapidly approaching 
Rome, justify the belief, says Neuburger, that it was not 
fear of personal violence at the hands of his jealous rivals 
that drove Galen away so mysteriously from the city in 
which, in the short space of four or five years, he had won 
so great professional success, but an unwillingness to face 
his duty, which was, to remain and aid in the approaching 
fight against the great destroyer — the Plague. If Galen 
had been a simple physician, one of the great body of med- 
ical practitioners in Rome, no one would be disposed to 
question the justice of the criticism which the distinguished 
Viennese historian makes of his decision to abandon that 
city at the moment of her distress and peril. But, as a 
matter of fact, Galen was not a practitioner of medicine 
in the full sense of that term. He treated cases of illness 
because in no other way would it be possible for him to 
acquire the necessary familiarity with disease ; but, almost 
from the very beginning, he seems to have fully realized 
that he was destined to devote his time and his energies to 
a very different kind of professional work, — ^work which 
was urgently needed, which promised to be of very great 



CLAUDIUS GALEN 165 

value to medical science, and which probably no other 
physician then living was competent to do effectively. 
Furthermore, he was himself profoundly conscious that the 
work in question constituted the main object of his life. 
His own words (see his statement with reference to Archi- 
genes, on page 174) show this plainly, and the huge mass of 
medical treatises which he wrote reveal in the most un- 
mistakable manner with what untiring persistency he pur- 
sued the path which he believed it was his duty to follow. 
It being assumed, then, that such were the motives which 
actuated Galen, was it a mistake on his part to conclude 
that duty did not require him to remain in Rome? The 
question is a difficult one to answer, and I do not feel called 
upon to decide it. We do not, however, brand a general 
in the army a coward because he endeavors to protect him- 
self as much as possible from danger during a battle, that 
he may be able, to the very end, to direct the soldiers under 
his command. Similarly, was not Galen justified in avoid- 
ing every risk which was likely to imperil the performance 
of duties which were of far greater value to medicine and 
to humanity at large than that of acting as a mere soldier 
in the ranks of medical men ? 

It seems a great pity that one of the most inspiring fig- 
ures in the history of medicine should be represented to 
posterity with such a blemish upon his character, and I 
have therefore ventured to suggest a possible defense of 
Galen's action. 

Not very long after he had returned to Pergamum, 
Galen was summoned by the Emperors Marcus Aurelius 
and Lucius Verus, who were then with the army at Aqui- 
leia, a few miles north of the present Trieste, to join them 
at that city; and he was, of course, obliged to obey. A 
fresh outbreak of the Plague had occurred and there had 
already been many fatal cases among the troops. It was 
therefore decided by the emperors, almost immediately 
after Galen's arrival, to return to Rome with a part of 
the army. A start was accordingly made, and the company 
had already advanced some distance on their way, when 
Lucius Verus died. This unexpected event greatly in- 



166 GROWTH OF MEDICINE 

creased the difficulties of the return journey, as it was 
deemed necessary to carry the remains of the deceased 
Emperor back to the imperial city. Thus Galen found 
himself once more settled in Rome, this time in the capacity 
of private physician to the Emperor Marcus Aurelius and 
his sons Commodus and Sextus. The position was ex- 
tremely well adapted to the needs of Galen, who, from that 
time forward, for a period of several years, had at his 
disposal ample time for writing and for conducting his 
experimental work in anatomy and physiology, a privilege 
of which he appears to have made excellent use. He lived 
to be seventy years of age, his death occurring during the 
latter part of the reign of Severus, or at the beginning 
of that of Caracalla (about 201 A. D.). 

All Galen's critics agree that he possessed his full share 
of peculiarities, — not to call them by the harsher name of 
faults. He was constantly ready, for example, to praise 
his own doings and sayings, and he rarely lost an oppor- 
tunity of holding up the physicians of Rome to ridicule and 
contempt^ He was specially bitter in his criticisms of 
Methodism and its adherents — ''the donkeys of Thessa- 
lus," as he called them. At the same time, no other physi- 
cian of ancient or modern times has manifested to an equal 
degree such extraordinary industry as a writer and original 
investigator in a great variety of departments of knowl- 
edge. Although many of his works have been lost,^ those 
which have come down to our time are still very numer- 
ous — ' ' a sufficient number, ' ' says Neuburger, ' ' to constitute 
a library by themselves." I give here a few of the titles 
of these works, in order that the reader may get at least 
some idea of the great variety of medical topics which 
Galen has discussed in his writings. The more complete 
list furnished by Daniel Le Clerc contains nearly two 
hundred titles, and yet even this is believed to fall short 
of the actual number. 

1 The majority of the writings of Galen are reported to have been kept, for 
safe preservation, in the Temple of Peace, near the Forum ; and the destruc- 
tion of this building by fire, during the latter half of the second century, en- 
tailed the loss of all these valuable works. 



CLAUDIUS GALEN 167 

SELECTED LIST OF THE WOEKS OF GALEN EELATING TO 
MEDICINE. (FEOM LE CLEEC.) 

Explanation of some of the Ancient Terms Employed by 
Hippocrates. 

On the Establishment of the Art of Medicine. 

Definitions of Medical Terms. 

On the Different Sects in Medicine. 

Discourse against the Empirics. 

On the Importance, for a Physician, of a Thorough training in 
Philosophy. 

The Physician; or Introduction to Medicine. 

The Elements, as taught by Hippocrates. (2 books.) 

The Different Temperaments. (3 books.) 

On the Nature of Man; Commentaries on two Books of Hip- 
pocrates. (2 books.) 

The Humors. 

Do the Arteries Normally contain Blood ? 

On Black Bile. 

On the Bones. (For Students in anatomy.) 

Dissection of the Vocal Organs. 

The Anatomy of the Eyes. 

Dissection of the Veins and Arteries. 

Dissection of the Nerves. 

On the Utility of the Different parts of the Body. (17 books.) 

On the Natural Faculties. (3 books.) 

The Sentiments of Hippocrates and of Plato. (9 books.) 

The Organ of Smell. 

The Movements of the Muscles. (2 books.) 

The Physiology of Respiration. 

On Obesity. 

On the Maintenance of Health. (6 books.) 

The Characteristics of Different Foods. (3 books.) 

Precepts regarding the Diet best suited to the Four Different 
Seasons and to Each of the Twelve Months of the Year. 

On the Manner of Living best suited to those who Wish to Pre- 
serve their Health. (3 books.) 

On Habit. 

On the Differences between Diseases. 

On the Causes of Diseases. 

On Marasmus or Consumption. 

On the Different Kinds of Fevers. (2 books.) 

On Thirst. 



168 GROWTH OF MEDICINE 

On the Parts of the Body Affected. (6 books.) 
The Diseases of Women. 
The Different Kinds of Pulse. (16 books.) 
The Different Kinds of Urine. 
On Critical Days. (3 books.) 

Commentaries on the Treatises of Hippocrates. (39 books.) 
On the Manner of Treating Different Maladies. (17 books.) 
On Venesection. (3 books.) 
On the Use of Cups, Leeches and Scarifications. 
On Purgatives. (3 books.) 
On Colic. 
On Jaundice. 

On Gout. / 

On Stone in the Bladder. 
Etc. 

The numerous works of Galen, says Pagel, constitute a 
complete and very satisfactory encyclopaedia of medicine. 
The most available edition of his works in Greek is that 
of Karl Gottlob Kiihn of Leipzig (1821-1828; 22 Vols, of 
about 1000 pages each). There is scarcely a department 
which this great physician has not treated quite fully. 
But, unfortunately, the translations into modern languages 
are relatively few, and they cover only small portions of 
the entire work. That of Daremberg, entitled '^Oeuvres 
anatomiques, physiologiques et medicales de Galien, etc.^* 
(Paris, 1854-1857; 2 Vols.), is in every way most satis- 
factory, and it is from this source that I have made a few 
extracts — ^just sufficient to give the reader some idea of 
Galen 's style of writing and of his competency to deal with 
such subjects as human anatomy and physiology. To 
attempt anything like a complete exposition of his views 
regarding pathology, therapeutics, hygiene, etc., would 
necessitate my devoting more space to this part of the 
history of medicine than I can afford to give. To those 
who desire to obtain more ample information about 
Galen's views regarding pathology and therapeutics I 
would recommend a study of Daremberg 's admirable work 
and a perusal of the careful analysis made by Neuburger 
of certain portions of Galen's text. 

Galen's Contributions to Anatomy and Physiology. — ^At 



CLAUDIUS GALEN 169 

the period of time about which I am now writing, and for 
many centuries afterward, there existed among all classes 
of the community a very strong prejudice against dissecting 
human corpses. And even Galen himself appears to have 
shared this prejudice, for, in spite of his intense eagerness 
to gain a more perfect knowledge of human anatomy, he 
apparently did not dare to undertake any such investiga- 
tion, even when a favorable opportunity for so doing pre- 
sented itself, as it did on the occasion to which he refers 
in the following brief extract taken from one of his 
treatises : — 

A carelessly constructed sepulchre on the banks of a river had 
been undermined during a season of flood, and the corpse thus set 
free had floated down stream a short distance, until it finally 
lodged on the shore of a small cove. Passing near by I had the 
opportunity of inspecting this corpse. The fleshy parts had already 
disappeared to a great extent through the process of decomposition, 
but the bones were still held together by their fibrous connections. 
The picture presented to the eye was that of a human skeleton 
specially prepared for the instruction of young physicians. On 
another occasion, a few steps from the main road, I came across 
the dead body of a robber who had been killed by the traveler 
whose money he had attempted to steal. The peasants of that 
neighborhood were not willing to bury the corpse of such a bad 
man, and they accordingly allowed it to remain at the spot where 
it was first discovered. In the course of the following two days, 
as might be expected, the vultures removed every particle of flesh 
from the bones, so that, when I saw what remained of the body, 
the only thing visible was a nicely cleaned skeleton. 

(Le Clerc: Histoire de la Medecine, p. 711.) 

Here were two excellent opportunities for gaining the 
additional knowledge of human anatomy which Galen so 
much desired, but he evidently was not at all disposed to 
avail himself of them — doubtless because his mind was 
deeply imbued with the feeling that any such interference 
on his part would be a sacrilegious act. Under the circum- 
stances, therefore, there was nothing left for him to do but 
to utilize animals for purposes of dissection, and more 
particularly apes, whose anatomy very closely resembles 



170 GROWTH OF MEDICINE 

that of the human being. Several of Galen's books on 
anatomy have come down to our time, but quite a number 
of others have been lost. From those which we possess, 
and especially from the one entitled ''Anatomical Admin- 
istrations," it is permissible to conclude that he was a 
most skilful dissector and an extremely close and careful 
observer, and that he was very particular to set down 
the results of his observations in admirably clear language. 
Indeed, Le Clerc assures us that Vesalius, the great Flemish 
anatomist of the sixteenth century, bestowed high praise 
upon Galen's anatomical descriptions; and that, too, not- 
withstanding the fact that the latter sometimes erred in 
his statements regarding the similarity between certain 
parts observed in dissections of an animal and the corre- 
sponding parts in man. In one of his treatises- Galen 
states distinctly that the arteries contain blood. In another 
he gives a remarkably full and accurate description of the 
nervous system, including the brain, spinal cord, and many 
of the nerves. 

He describes the optic nerve, the oculo-motorius and trochlearis, 
the different ramifications of the trigeminus, the acusticus and 
facialis, the vagus and glossopharyngeus, the nerves of the pharynx 
and larynx, the sympatheticus (with the accompanying ganglia), 
and the radial, ulnar, median, crural and ischiatic nerves. (Pusch- 
mann. ) 

Although it is true that certain important anatomical and 
physiological facts are found recorded for the first time 
in the works of Galen, this must not be accepted as evidence 
that Galen himself is the real discoverer of these facts. 
The most that can be claimed for him is that he is the first 
writer to bring the facts in question to the knowledge of 
us moderns. When the ancient books that have been lost 
are once more brought to light, as they very well may be 
at any time, we shall be able, perhaps, to give credit where 
credit is due. But there is one department in which Galen 
did experimental work of an entirely original character and 
for which he deserves unstinted praise. I refer to the 
experiments which he made concerning the physiology of 

2 Book VI., Chapter XVII. (page 441 of Vol. I. of Daremberg's version). 



CLAUDIUS GALEN 171 

the brain and spinal cord. They are related in the 
following extract, which has been translated from the 
account given by Neuburger {op. cit., Vol. I., p. 380) : — 

The brain itself is not sensitive; it expands and contracts 
synchronously with the respiratory movements, the purpose of 
which action is to drive the pneuma from the cavities of that organ 
into the nerves. The function of the meninges is to hold the parts 
firmly together and to unite the blood-vessels. Pressure upon the 
brain causes stupor. An injury of the tissues surrounding the 
fourth ventricle or of those which constitute the beginning of the 
spinal cord produces death. The seat of the soul is in the sub- 
stance of the brain, and not in its membranes. The spinal cord 
serves as a conductor of sensation and of motor impulses, and it 
also plays the part of a brain for those structures of the body 
which lie below the head. It gives off nerves like streamlets. 
Division of the spinal cord longitudinally in its median axis does 
not give rise to paralysis. Transverse division, on the other hand, 
causes symmetrical paralyses. If the cord is divided between the 
third and fourth cervical vertebrae, respiration is arrested, and 
if the division is made between the cervical and the thoracic por- 
tions of the spinal column, the animal breathes with the aid only 
of its diaphragm and of the upper muscles of the trunk of the 
body. Division of the recurrent nerves produces aphonia; if the 
fifth cervical nerve is divided, the scapular muscles on the corre- 
sponding side will be paralyzed. Galen considers the ganglia to 
be organs for reinforcing the energy of the nerves. The fact that 
both cerebral and spinal-cord nerve-filaments enter into the com- 
position of the sympathetic nerve explains the extraordinary 
sensitiveness of the abdominal organs. 

When we consider that these experiments are the first 
of their kind of which history makes mention, that they 
were carried out nearly seventeen hundred years ago, and 
that — so far as we know — they sprang entirely from the 
brain of the experimenter, we may well express unlimited 
admiration for Claudius Galen. 

Daniel Le Clerc says that Galen's principal treatise on 
human physiology, entitled ''Utility of the Different Parts 
of the Human Body," constitutes a chef-d'oeuvre which 
has challenged the admiration of physicians and phi- 
losophers in all ages. Christians, however, he adds, are 



/V 



172 GROWTH OF MEDICINE 

particularly gratified to learn from this work that ' ' Galen, 
although classed as a Pagan, unhesitatingly recognizes that 
it was an all-wise, an all-powerful, an all-good God who 
created man and all the other animals." Further on, 
Le Clerc refers to another statement which was made by 
Galen and which will be found on page 261 of Daremberg's 
version. It reads as follows: — 

If I were to spend any more time in talking about such brutes — 
by which term he designates men who cannot appreciate the wisdom 
of God in distributing the different parts of the body in the manner 
in which He has done this — I should justly incur the blame of 
sensible persons. They would accuse me of desecratiag the account 
which I am writing, an account which is intended as a hymn of 
sincere praise of the Creator of man. I believe that true piety 
consists, not in sacrificing numberless hecatombs nor in burning 
unlimited quantities of incense and a thousand perfumes, but in 
first searching out and then making known to my fellow men how 
great are the wisdom, the power, and the goodness of the Creator. 

Galen's work on ''The Utility of the Different Parts of 
the Human Body" is composed of seventeen books, all of 
which exist to-day in a complete state. Taken together 
they form, as may be seen by the following list of contents, 
a remarkably complete treatise on physiology. Books I. 
and II. are devoted to the hand, forearm and arm (105 
pages) ; Book III. to the thigh, leg and foot (62 pages) ; 
Books IV. and V. to the alimentary organs and their 
accessories (101 pages) ; Book VI. to the respiratory organs 
(78 pages) ; Book VII. to the organs of the voice (67 pages) ; 
Book VIII. to the head, the encephalon and the organs of 
special sense (45 pages) ; Book IX. to the cranium, the 
encephalon and the cranial nerves (38 pages) ; Book X. to 
the eyes and their accessories (45 pages) ; Book XL to the 
face and more particularly the jaws (55 pages) ; Book 
XII. to the neck and the rest of the spinal column (46 
pages) ; Book XIII. to the shoulder and the structure of 
the spinal column in detail (40 pages) ; Books XIV. and XV. 
to the genital organs and the parts in which the foetus 
develops (70 pages) ; Book XVI. to the nerves, arteries 
and veins (43 pages) ; and Book XVII. Epilogue (11 pages). 



CLAUDIUS GALEN 173 

There are very few modern text books in which the 
author treats the subject in as exhaustive a manner as 
Galen has done in these seventeen books. As may readily 
be imagined from the great number and length of his 
writings, he often wanders off into side issues and thus 
lays himself open to the charge of being a diffuse writer. 
At the same time he cannot be accused of dullness, for in 
reading Daremberg's version one is seldom tempted to 
omit any of the text, and his style is interesting. The 
following brief extracts, to which should be added that 
given on a previous page, may be taken as fair samples of 
his manner of treating questions in the department of 
physiology : — 

Reasons why the Alae Nasi are Cartilaginous and why they may 
he Moved by Voluntary Muscular Action. — ^We have already 
explained in some measure the reasons why the alae nasi should 
be composed of cartilage and why it should be possible for the 
animal to move them at will.^ It is an established fact that the 
movements of these parts are competent to aid in no small degree 
the somewhat forcible inspirations and expirations. This is the 
reason why the alae are constructed in such a manner as to be 
easily movable. They are made of cartilage because this substance 
is hard to fracture or to tear apart. The placing of these alar 
movements under the control of the will, and not under that of 
some other bodily force (like the arterial impulse, for example), 
is certainly an excellent arrangement; and, if one does not appre- 
ciate this without any further explanation, it must be because my 
previous reasonings about such matters have fallen upon inatten- 
tive ears. 

(Translated from Book XI., Chapter XVII., of Daremberg's 
French version of Galen's works.) 

Another brief extract may be given here. It forms a 
part of the chapter relating to the action of the sigmoid 
valves of the pulmonary artery, etc., and merits special 
attention because it furnishes additional evidence of the 

8 In his Commentaries on the works of Hippocrates (Epidemic Diseases, 
III., t. XVII. B. $ 4) Galen states that he has often observed this to-and- 
fro movement of the alae nasi in certain cases of illness and that he has 
interpreted it as indicating the existence of some serious disorder of the 
respiratory tract. (Daremberg.) 



/J 



174 GROWTH OF MEDICINE 

correctness of Daremberg's statement that Galen was the 
leader of the most advanced school of experimentation: — 

The more strongly the thorax, in its exertion of a compressing 
force, tends to drive the blood (out of the heart), the more tightly 
do these membranes (the sigmoid valves) close the opening. 
Invested in a circular manner from within outward, extending 
throughout the entire circumference of the interior of the vessel, 
these membranous valves are, each one of them, so accurately 
patterned and so perfectly fitted that when they are put upon the 
stretch by the column of blood, they constitute a single large 
membrane which closes (watertight) the orifice. Pushed back by 
the return flow of the blood, they fall back against the inner sur- 
face of the vein, and permit an easy passage of the blood through 
the amply dilated orifice (which they, an instant before, closed so 
perfectly). 

(Translated from Book VI., Chapter XI., of Daremberg's French 
version of the works of Galen.) 

In his comments upon the account of the sigmoid valves 
which I have just quoted, Daremberg says that the descrip- 
tion of these structures given by Erasistratus at least four 
hundred years earlier is admitted by Galen to be so correct 
that it would scarcely be possible to furnish a better one. 

Galen's Remarks upon, the Subject of Diagnosis. — In the 
treatise entitled ''On the parts of the Body Affected" 
(Book IL, Chapter X.) Galen gives the following advice 
with regard to the method which it is desirable to adopt 
when one wishes to ascertain which part or organ is 
affected, what is the nature of the disease there located, 
and whether it is primary in its nature or secondary to 
some affection of earlier development: — 

It should have been the special duty of Archigenes, who appeared 
on the scene next in order after a series of the most illustrious 
physicians,* to infuse more light into medical teaching. Unfortu- 

4 Hippocrates, Herophilus, Erasistratus, Asclepiades, Themison, Celsus, Sora- 
nus and Athenaeus. Daremberg calls attention to the fact that, although we 
possess to-day only a few fragments of the writings of Archigenes, those few 
are of such a degree of excellence that we may well ask ourselves whether 
Galen was not perfectly justified in placing such a high estimate as he ap- 
pears to have done upon the merits of this writer, — and that, too, notwith- 



CLAUDIUS GALEN 175 

nately, he did the very opposite ; for we who have grown old in the 
exercise of the art (and should therefore find it easy to comprehend 
what is written about medicine), are at times unable to understand 
what he says. Such being the true state of affairs, I now propose 
to undertake what Archigenes failed to accomplish. I shall com- 
mence by indicating in a general way what is the proper method 
to adopt when one wishes to ascertain in what part or organ the 
disease is located and how one should proceed when it is proposed 
to teach the method to others. This method may be stated in the 
following terms : — 

In the first place, the part should be carefully examined in order 
that we may ascertain whether it presents any signs of special 
value as indicating the nature of the disease. In the next place, 
it is important in such an examination to know beforehand what 
are the particular signs which belong to each of the diseases that 
may affect the part or organ in question, and also whether these 
signs vary according to the particular section of the organ involved. 
In inflammation of the lung, for example, there are: difficulty in 
breathing (dyspnoea) and great general distress (malaise), the 
patient being obliged to remain in a sitting posture (orthopnoea) — 
all of which are signs indicating the possibility of suffocation. 
Furthermore, the air expired from the infected lung is sensibly 
hot, especially if the inflammation is of the erysipelatous variety, 
and, as a consequence, the patient shows a disposition to draw long 
breaths, knowing that the cold air which he thus draws into his 
lungs will afford him some measure of relief. The sputa expecto- 
rated when he coughs are differently colored; some being red, 
yellowish, or of a rusty appearance, while others are almost black, 
livid, or frothy. The patient also often experiences the sensation 
of a heavy weight in his chest, together with more or less pain, 
which seems to be located deep down in that region and which 
shoots backward into his spinal column or forward toward the 
sternum. Add to these manifestations a high fever and a pulse 
such as we have already described on another page, and you will 
have 

(Translated from Daremberg's French version of Galen's works.) 

It has been said that Galen possessed more than the 
ordinary share of vanity with regard to his cleverness as 

standing the unfavorable criticism which he makes in the present paragraph 
about the author's failure at times to write with sufficient clearness on med- 
ical subjects. 



176 GROWTH OF MEDICINE 

a diagnostician; and certainly some of the accounts which 
he gives, in his clinical and scientific treatises, of his own 
experiences, seem to bear out this accusation. One hesi- 
tates to expose the weak spots in the character of one of 
the really great men of antiquity lest such exposure may 
convey a wrong impression; at the same time it would be 
an error to represent him as a man entirely free from the 
foibles common to humanity, — even to the best and wisest 
of men. I therefore repeat here Galen's own account of 
a professional visit which he made to a brother physician 
whose malady presented to himself and to his friends many 
obscure features. 

Upon the occasion of my first visit to Rome I completely won the 
admiration of the philosopher Glaucon by the diagnosis which I 
made in the case of one of his friends. Meeting me one day in the 
street he shook hands with me and said : "I have just come from 
the house of a sick man, and I wish that you would visit him with 
me. He is a Sicilian physician, the same person with whom I was 
walking when you met me the other day." "What is the matter 
with him?" I asked. Then coming nearer to me he said, in the 
frankest manner possible : ' ' Gorgias and Apelas told me yesterday 
that you had made some diagnoses and prognoses which looked to 
them more like acts of divination than products of the medical art 
pure and simple. I would therefore like very much to see some 
proof, not of your knowledge but of this extraordinary art which 
you are said to possess." At this very moment we reached the 
entrance of the patient's house, and so, to my regret, I was pre- 
vented from having any further conversation with him on the 
subject and from explaining to him how the element of good luck 
often renders it possible for a physician to give, as it were off- 
hand, diagnoses and prognoses of this exceptional character. Just 
as we were approaching the first door, after entering the house, 
we met a servant who had in his hand a basin which he had 
brought from the sick room and which he was on his way to empty 
upon the dung heap. As we passed him I appeared not to pay 
any attention to the contents of the basin, but at a mere glance I 
perceived that they consisted of a thin sanio-sanguinolent fluid, 
in which floated excrementitious masses that resembled shreds of 
flesh — an unmistakable evidence of disease of the liver. Glaucon 
and I, not a word having been spoken by either of us, passed on 
into the patient's room. When I put out my hand to feel of the 



CLAUDIUS GALEN 177 

latter 's pulse, he called my attention to the fact that he had just 
had a stool, and that, owing to the circumstance of his having 
gotten out of bed, his pulse might be accelerated. It was in fact 
somewhat more rapid than it should be, but I attributed this to 
the existence of an inflammation. Then, observing upon the window 
sill a vessel containing a mixture of hyssop and honey and water, 
I made up my mind that the patient, who was himself a physician, 
believed that the malady from which he was suffering was a 
pleurisy; the pain which he experienced on the right side in the 
region of the false ribs (and which is also associated with inflam- 
mation of the liver) confirming him in this belief, and thus induc- 
ing him to order for the relief of the slight accompanying cough 
the mixture to which I have just called attention. It was then 
that the idea came into my mind that, as fortune had thrown the 
opportunity in my way, I would avail myself of it to enhance my 
reputation in Glaucon 's estimation. Accordingly, placing my hand 
on the patient 's right side over the false rib, I remarked : ' * This 
is the spot where the disease is located." He, supposing that I 
must have gained this knowledge by simply feeling his pulse, 
replied with a look which plainly expressed admiration mingled 
with astonishment, that I was entirely right. "And" — I added 
simply to increase his astonishment — "you will doubtless admit 
that at long intervals you feel impelled to indulge in a shallow, 
dry cough, unaccompanied by any expectoration. ' ' As luck would 
have it, he coughed in just this manner almost before I had got 
the words out of my mouth. At this Glaucon, who had hitherto 
not spoken a word, broke out into a volley of praises. "Do not 
imagine," I replied, "that what you have observed represents 
the utmost of which medical art is capable in the matter of fathom- 
ing the mysteries of disease in a living person. There still remain 
one or two other symptoms to which I will direct your attention. ' ' 
Turning then to the patient I remarked: "When you draw a 
longer breath you feel a more marked pain, do you not, in the 
region which I indicated; and with this pain there is associated 
a sense of weight in the hypochondrium ? " At these words the 
patient expressed his astonishment and admiration in the strongest 
possible terms. I wanted to go a step farther and announce to 
my audience still another symptom which is sometimes observed 
in the more serious maladies of the liver (scirrhus, for example), 
but I was afraid that I might compromise the laudation which 
had been bestowed upon me. It then occurred to me that I might 
safely make the announcement if I put it somewhat in the form 



178 '■ GROWTH OF MEDICINE 

of a prognosis. So I remarked to the patient: "You will prob- 
ably soon experience, if you have not already done so, a sensation 
of something pulling upon the right clavicle." He admitted that 
he had already noticed this symptom. "Then I will give just 
one more evidence of this power of divination which you believe 
that I possess. You, yourself, before I arrived on the scene, had 
made up your mind that your ailment was an attack of pleurisy, 
etc." 

Glaucon's confidence in me and in the medical art, after this 
episode, was unbounded. 

Thirty or forty years elapsed after Galen's death before 
the Profession began to realize how great an authority he 
had become in all matters relating to medicine ; not perhaps 
among the majority of physicians, but among the better 
educated and those more given to reasoning about the 
various problems in physiology and pathology. Then came 
the invasion of Eome by the Barbarians, and with it the 
scattering of nearly all those who were at the time prac- 
ticing medicine in that great city. This was the beginning 
of the long period known as the Middle Ages, a period 
during which, so far as Italy and Gaul were concerned, the 
science of medicine made no advance whatever. The 
physicians living in a precarious manner in the to^vns, and 
the monks who practiced medicine in the country districts, 
took very little interest, as may readily be imagined, in the 
achievements of Galen. Through all those years they 
clung to the doctrines of the Methodists, as revealed to 
them in the work of Caelius Aurelianus, the favorite 
medical treatise of that period. It was only during the 
latter part of the Middle Ages that Galen's teachings 
began once more to be appreciated at their true value; 
and, as time went on, they gained a stronger and stronger 
hold on the minds of medical men, until finally they held 
undisputed sway. Friedlaender, speaking of medicine in 
those dark times, uses these words: *' Galen's colossal 
personality loomed up throughout that long night as a 
brilliant guiding star to light the intricate pathways of 
medicine. ' ' 



CHAPTER XVI 

THE INFLUENCE OF CHRISTIANITY UPON THE 
EVOLUTION OF MEDICINE 

The religion established by Jesus Christ in Judea during 
the early part of the first century remained confined within 
the limits of that region for a number of years, but already 
during the latter half of that period groups of Christians 
were to be found in every part of the Roman Empire, and 
in certain localities the membership of the new church had 
increased so greatly in numbers as to excite the alarm and 
hostility of the temple priests and of the governing officials. 
Persecutions, especially in the city of Rome and at the 
instigation of Nero, became more and more frequent and 
more and more pitiless, but they failed utterly to destroy 
the new religion, so firmly was it rooted in the followers 
of Jesus Christ. As a matter of fact its spread was 
checked for only a few years, and then its adherents 
increased in numbers more rapidly than ever. Neuburger, 
in his '* History of Medicine," makes the following quota- 
tion from the account which Dionysius of Alexandria gives 
of the great plague that occurred during the third century 
A. D.: 

The majority of our brethren in their love for their neighbors 
did not spare themselves, but acted as a unit in their efforts to 
assist. They visited the sick without the slightest fear and gave 

them the very best of care, for the sake of Christ Among 

the non- Christians, however, the very opposite was true. As soon 
as any of their number fell ill they pushed them to one side, even 
those who were dearest to them, and, before they were more than 
half-dead, they threw them out into the street and took no care to 
bury the dead bodies. 



180 GROWTH OF MEDICINE 

Such an example of self-sacrifice and humanity — and 
there must have been very many similar examples — could 
not possibly have failed to make a profound impression 
upon the community at large. Daniel Le Clerc says that 
three physicians suffered martyrdom for their Christian 
faith during the reigns of the Emperors Marcus Aurelius, 
Lucius Verus and Commodus. They were Papila (of 
Pergamum), Alexander (of Lyons) and Sanctus (a con- 
temporary of Galen), whose death was of a particularly 
cruel character. Credit should also be given to Chris- 
tianity, says the same writer, for having established the 
rule that every community should assume the expense and 
responsibility of caring for its own poor and sick. This 
was a step of the greatest importance ; and, at a still later 
period, when Christianity became largely an affair of the 
state, a complete hospital organization was effected, with 
the bishop as the chief officer and, under him, deacons and 
deaconesses. Such well-organized institutions proved to 
be of the greatest possible benefit to the advance of medical 
science. They were the worthy successors of those more 
ancient hospitals, the Aesculapian temples, which were first 
established by the Greeks in the pre-Hippocratic age, and 
they have continued in an unbroken chain from the institu- 
tions of those primitive times to the thoroughly well- 
equipped hospitals of the present day. 

In 330 A. D. the new capital of the Eoman Empire was 
established in Byzantium, afterward called Constanti- 
nople, and Eome, which for hundreds of years had been 
the metropolis of the world and the source from which a 
large part of Roman history had emanated, was given a 
subordinate position. Then followed, in 410 A. D., the 
conquest of the latter city by the Visigoths, a horde of 
uneducated Barbarians who had felt the might of Rome 
in previous years, and who now doubtless took immense 
satisfaction in humiliating her and in destroying her 
valuable possessions. There are good reasons for believing 
that, when the Emperor Constantine established his resi- 
dence in Byzantium, the leading physicians of Rome 
followed him ; and it is not likely that many of those who, 



TEE INFLUENCE OF CHRISTIANITY 181 

for one reason or another, preferred to remain in the old 
capital, continued to do so after it became known that the 
Barbarians were approaching the city. But the migration 
of these physicians to the new capital did not mean a 
renewal there of the scientific activity which had charac- 
terized the growth of Greek medicine in Rome during the 
first two centuries of the Christian Era. It is probable that 
the fugitives, being obliged to travel with the smallest 
amount of baggage possible, left the major part of their 
books and papyrus rolls behind, hoping, no doubt, that they 
might be able at some later date to recover them. But the 
favorable occasion never arrived, and thus a great deal 
of valuable medical literature entirely disappeared. The 
loss, however, might have been even more serious than it 
was if the Christian church had not already (during the 
third century) begun to establish monasteries in secluded 
and inaccessible spots. It was to these institutions that 
not only books of a religious character, but also those 
relating to the science of medicine, were transported for 
safe keeping during the early Middle Ages. Farther on, 
I shall have occasion to refer to this subject again and to 
discuss more fully certain other benefits which accrued 
to medical science from these monastic institutions. 

But while, on the one hand, the Christian church through 
the instrumentality of the monasteries was lending its aid 
to the preservation of the sources of medical knowledge, 
it was, on the other, doing its best to arrest all further 
evolution of that branch of science; not consciously, it 
must be admitted, but through a mistaken sense of its duty 
to God. Thus it came about that the Emperor Justinian I. 
(527-567 A. D.), acting under the narrow-minded advice of 
his ecclesiastical counsellors, closed the medical schools at 
Athens and Alexandria and at the same time withdrew the 
regular allowance of money which up to that time had been 
paid to the state physicians and to special scholars. A 
few years later, however {i.e., in the early part of the 
seventh century A. D.), some of the more highly educated 
physicians of Alexandria got together and made the 
attempt to organize a school of medicine in that city. A 



182 GROWTH OF MEDICINE 

course of lectures was planned and sixteen of Galen's 
works, carefully chosen for the purpose, were made the 
basis of the new course of instruction. The books selected 
were first carefully edited and simplified, and then commen- 
taries were added in order that in their final >shape these 
treatises might be better suited to the uses of students. 
The invasion of Alexandria by the Arabs, however, soon 
put an effectual stop to this promising attempt to revive 
Greek medicine. 

In this brief sketch I have thus far mentioned only the 
more direct effects produced by the new religion upon the 
evolution of medicine. The indirect effects, however, were 
also in some cases of very great importance. At the 
beginning of her history there developed in the Christian 
church, among her chief men, a strong disposition to 
quarrel over dogmas. To apply the term quarrelsomeness 
to this tendency may easily convey a wrong impression. 
It was, more strictly speaking, a highly developed con- 
scientiousness on the part of men whose minds were deeply 
imbued with the idea that they were rendering God a service 
by keeping what they believed to be the true and only 
religion free from errors of all kinds. It took many 
centuries to impress the leaders of the church with the 
fact that the religion of Jesus Christ, like the science of 
medicine or the natural sciences, was capable of develop- 
ment to an almost indefinite extent ; and it is owing to our 
appreciation of this important fact that we moderns look 
with so much more lenient eyes upon the distressing, not 
to say cruel, events of mediaeval ecclesiastical history. 
At the time of which I am now writing, however, it was 
considered highly unchristian — especially for one holding 
authority in the church — to believe otherwise than as her 
doctrines taught; and accordingly, in the early part of the 
fifth century A. D., Nestorius, the Patriarch of Constanti- 
nople, was deposed from his high office by a Council of the 
church and imprisoned because he was unwilling to teach 
the doctrine of the miraculous birth of Jesus Christ. 
Those who accepted the view held by Nestorius — and they 
eventually became a very numerous and a very influential 



THE INFLUENCE OF CHRISTIANITY 183 

body of Christians — ^were driven out of Constantinople and 
compelled to seek homes in distant places. This affords, 
perhaps, an explanation of the fact that, during the eighth 
century A. D., many Nestorian Christians were found living 
in the eastern part of Syria and in Persia; and it seems 
fair to assume that these Christian communities repre- 
sented to some extent the direct successors of those Nesto- 
rians who had taken refuge in this remote corner of Asia 
Minor three hundred years earlier. Furthermore, it is 
highly probable that there were Christian communities in 
this region several centuries before the Nestorians arrived, 
for it is believed that the Apostles James and Thomas 
visited Persia and the northeastern part of Syria in the 
course of their work as evangelists. It is not known, 
though, how many of the descendants of these earlier 
Christians adopted the peculiar beliefs of the Nestorian 
refugees. 

And here it should be stated that the facts which have 
thus far been mentioned are not the only ones that throw 
some light upon the relationship subsisting between Chris- 
tianity and the spread of medical knowledge to Western 
Europe. Those which remain to be considered are of two 
kinds, viz., facts relating to the origin of the Arabic 
Renaissance, and facts which show that the Christian 
church, from the fourth century onward, was contributing 
not a little, through the establishment of the great monastic 
orders, such as the Benedictines, the Dominicans, and the 
Franciscans, to the preservation if not to the further 
evolution of Graeco-Roman medical knowledge. I shall 
reserve for consideration in a later chapter this particular 
part of the history of medicine; and in the meantime I 
shall endeavor to describe the events which preceded and 
rendered possible the active study of Greek medicine on 
the part of the followers of Mohammed. 

So far as history furnishes us with any information on 
the subject, the Nestorians who lived in Persia, Syria and 
Mesopotamia were Christians of a remarkably liberal type. 
They appear to have been an unusually peaceable people, 
for not only were they kindly disposed toward one another, 



184 GROWTH OF MEDICINE 

but they seem to have been on the best of terms with their 
Jewish neighbors, who, like themselves, were eager after 
knowledge. Already at a very early period there existed 
at Djondisabour — a town which had been founded in the 
Province of Khorassan, in the northeastern part of Persia, 
about the year 260 A. D., by Sapor II., King of that 
country — a school in which the medicine of Hippocrates 
was taught. Freind, in his ''History of Physick" (London, 
1727), says that about the year 272 A. D. the Emperor 
Aurelian (Lucius Domitius Aurelianus), as a compliment 
to his daughter, who was the wife of the King of Persia, 
sent to Djondisabour, the city in which she resided, several 
Greek physicians; and Abulpharagius, the Arab historian 
(thirteenth century), intimates that these were the men who 
conducted the teaching in the newly established medical 
school. Another possibility suggests itself. After the 
death of Alexander the Great in Babylon (323 B. C), from 
malarial fever, it is not unlikely that some of the numerous 
Greek physicians who accompanied the army in an official 
character, and who, we are warranted in believing, were 
exceptionally well educated, decided not to remain in that 
unhealthy district, but to settle in some of the neighboring 
towns {e.g., Nisibis in the hill country to the north of 
Babylon, or Sura to the east of the river Tigris) ; and that 
these men also contributed their share toward the planting 
and perpetuation of Greek medicine in this district of the 
Orient. However, the salient fact in this period of the 
history of medicine is this: When Almansur, the Caliph 
of Bagdad (712 to 775 A. D.), made up his mind to introduce 
Greek medicine into his kingdom and looked around for 
the ways and means of accomplishing this, he found at the 
city of Djondisabour men who were not only well versed 
in Greek medicine, but who at the same time were so thor- 
oughly grounded in all departments of scholarship that 
they could at once begin the work of translating the writings 
of Hippocrates and other classical medical authors into 
Arabic, the language of the Mohammedans. But at this 
stage of affairs the existence of a serious obstacle was 
discovered. The writings which it was proposed to trans- 



THE INFLUENCE OF CHRISTIANITY 185 

late were not immediately obtainable, and it therefore 
became necessary to institute without delay a vigorous 
search for the books required. In order that the reader 
may appreciate fully the difficulties which Almansur had 
to overcome, in this matter of a scarcity of Greek originals, 
it seems best to pause at this point, and to review briefly 
some of the facts which bear upon the question at issue. 

The Wholesale Destruction of Medical Literature during 
the Early Centuries of the Christian Era. — The invasion 
of Eome in 410 A. D. was one of the first events which 
entailed a serious loss of the Greek medical books that had 
been accumulating for several centuries in that city. Fortu- 
nately, not a few of these works were rescued in time by 
the church authorities and deposited for safe keeping in 
the various monasteries scattered all over the Roman 
Empire. A still more serious destruction of books occurred 
about the year 638 A. D., when Amrou, a famous Arabian 
warrior, captured Alexandria and — under the instructions 
of his master, Omar ben Khattab — destroyed the greater 
part of the contents of the famous libraries located in that 
city. The narrative of this event, as told by Lucien 
Le Clerc, is as follows: — 

John the Grammarian,^ who was living at that time in Alex- 
andria, held the following conversation with Amrou on a certain 
occasion : * ' You have inspected all the edifices of Alexandria, and 
have sequestrated all their contents. I have no objections to your 
appropriating everything that may be of use to you; there are 
certain things, however, which you may not wish to possess, but 
which are highly prized by us. ' ' 

"What are those objects?" inquired Amrou. 

1 John the Grammarian, whose nativity is not stated by Le Clerc, was at 
first a simple boatman who ferried back and forth those who attended a school 
which was located on one of the islands at Alexandria. As a result of his 
frequent talks with these men, he became enamored with philosophy and 
decided, notwithstanding his age (forty years), to devote himself entirely 
to the study of the subject. Accordingly, he sold his boat and attended the 
lectures regularly, becoming at last an expert in philosophy. He wrote several 
important treatises and commentaries, some of them dealing with medical 
topics, and he also made a number of translations from the Greek into Arabic. 



186 GROWTH OF MEDICINE 

''The works on philosophy, which are contained in the public 
libraries," John replied. 

"I can do nothing about them without a special order from the 
Prince of Believers, Omar ben Khattab," was the answer given 
by Amrou. 

John's wish having in the meantime been conveyed by the 
General to Omar, the latter sent this reply : — 

"As to the books of which you speak, I have this to say. If their 
contents agree with what is written in the word of God, the books 
are of no use to us, the Holy Writ being sufficient for our guidance. 
But if they are at variance with God's word, then surely they 
should be destroyed." 

Amrou therefore ordered all the books to be sent to the bathing 
establishments of Alexandria, to be used as fuel in heating the 
baths. So great was the number of books contained in the libraries 
that it took six months to consume them all. (Sismondi questions 
the correctness of this account.) 

While the invasion of Rome by the Barbarians in the 
fifth century and the capture of Alexandria by the Arabs 
in the early part of the seventh gave rise to an enormous 
loss of valuable books relating to medicine and philosophy 
in general, these were by no means the only occasions when 
books were probably destroyed in great quantities. Wars 
were frequent in those days and towns were constantly 
being sacked. Everywhere throughout the East the modern 
traveler encounters the ruins of large cities, and in those 
cities — the centres, as they were, of wealth and culture — 
there must have been large collections of books. It is not 
at all strange, therefore, that when the Caliph Almansur 
made a serious beginning of the work which was to convert 
the Arabs into rivals of the ancient Greeks, he should have 
found a great scarcity of medical works which, after being 
translated, were to serve as manuals of instruction. How- 
ever, his ambition was very great, his wealth almost 
inexhaustible, and his associates eager to aid him in 
realizing the renaissance which he had planned for his 
people ; and, as will appear later on, he and those who aided 
him eventually succeeded in overcoming this apparently 
insurmountable obstacle. 



TEE INFLUENCE OF CHRISTIANITY 187 

Among the medical books which, upon the approach of 
the Goths, were carried from Eome and other cities to 
different monasteries for safe keeping there must have 
been very few that were written in Latin, and yet these 
were the only ones from which the monks individually 
could derive any benefit. Several centuries later, when all 
the monasteries of Italy and the East were visited by those 
who were searching eagerly for original manuscript-copies 
of the Greek medical writers, — Hippocrates, Soranus, 
Eufus of Ephesus, Aretaeus, Dioscorides, Galen, — it was 
found that such copies existed in a number of these insti- 
tutions, thus showing that the monks had been actuated 
by unselfish and far-seeing loyalty to the best interests of 
mankind when they rescued these particular treasures 
from the hands of the enemy. They themselves could make 
no use of them, being unable to read Greek, but they knew 
their priceless value to medical science. 

The Latin treatises which they had also rescued, and of 
which they made excellent use during the succeeding cen- 
turies, were those of Celsus, Scribonius Largus, Pliny the 
Elder (to a slight degree only) and Caelius Aurelianus. 



%\ 



/r1 



PART II 
MEDIAEVAL MEDICINE 



I'll 



CHAPTER XVII 

THE CONDITION OF MEDICINE AT BYZANTIUM 
DURING THE EARLY PART OF THE MIDDLE 
AGES 

The Byzantine period of the history of medicine begins 
about the middle of the fourth century A. D. and retains 
some degree of importance up to or perhaps a little beyond 
the beginning of the eighth century. During this period 
of nearly four centuries there appeared on the scene 
five physicians whose writings form a very creditable 
part of the late Greek medical literature. The names of 
these authors are : Oribasius, Aetius, Alexander of Tralles, 
Theodore Priscianus and Paulus Aegineta. 

Oribasius. — The first physician . named in this list, 
Oribasius, was born about the year 325 A. D. in Pergamum, 
an important city of Asia Minor and the birthplace of 
Galen. He received his medical training at Alexandria, 
settled in Constantinople (the new name given to Byzan- 
tium), and soon afterward became the personal physician 
of the Emperor Julian the Apostate, the nephew of 
Constantine the Great. Subsequently he was appointed 
Quaestor of Constantinople, but, upon the death of Julian 
(363 A. D.) and the accession of Valens and Valentinianus 
to power, his property was confiscated and he himself was 
obliged to take refuge among the Ostrogoths, who dwelt 
on the shores of the Black Sea. These people received 
him with open arms, and he soon acquired great influence 
among them. After a time, however, he was recalled to 
Constantinople and all his former privileges were once 
more granted to him. He died about the year 403 A. D. 



192 GROWTH OF MEDICINE 

Despite his duties as a practicing physician of the very 
highest rank — duties which he could not wholly set aside 
when he accepted the office of Quaestor of Constantinople — 
and despite the necessity of devoting considerable time to 
the work which this non-medical official position entailed, 
Oribasius, like Pliny, appears to have been a most energetic 
contributor to medical literature. We possess to-day, for 
example, a large part of the medical cyclopaedia (72 
books) which he prepared at the command of the Emperor 
Julian, and which — even in its incomplete state — contains 
very full information regarding anatomy, physiology, 
surgery, pathology and pharmacology. Although the work 
is simply a compilation, its present value is great, for it 
contains numerous extracts from earlier and contemporary 
treatises, many of which have entirely disappeared, — 
treatises of which we should have had no knowledge what- 
ever if Oribasius had not introduced numerous extracts 
from them into his cyclopaedia. 

About the year 390 A. D., when Oribasius was already an 
old man, he published (in nine books) a "Synopsis" of the 
larger work, chiefly for the benefit of his son Eustathios, 
who was at that time studying medicine. Surgery is 
omitted from this work, as that branch of medicine was 
assumed to belong entirely to specialists. At a still later 
date (about 395 A. D.), Oribasius published a third work 
(in four books) entitled "Euporista," which was intended 
chiefly for the use of laymen. The subject-matter of this 
treatise consists of diet, hygiene and general therapeutics. 
Neuburger speaks well of all three of the published works 
of Oribasius, and furnishes a fairly full analysis of the 
contents of each one. 

Bussemaker and Daremberg have published, in six 
volumes (Paris, 1856-1876), an excellent French version 
of the works of Oribasius. 

Priscianus. — Theodorus Priscianus lived during the 
latter part of the fourth and the first part of the fifth cen- 
tury of the present era. Very little is known about his 
professional career beyond the facts that he was a pupil 
of Vindicianus, a distinguished physician who lived during 



MEDICINE IN THE MIDDLE AGES 193 

the reign of the Emperor Valentinianus I. at Constanti- 
nople (364-375 A. D.), and that subsequently he was chosen 
the private physician of the Emperor Gratianus (375-383 
A. D.). The treatise which he composed, and which bore 
the title of ' * Euporiston, ' ' was originally written in Greek, 
but was afterward translated by its author into Latin. An 
excellent German version of the work by Meyer-Steineg 
was published in Jena in 1909. As the book was intended 
by Priscianus to serve chiefly as a guide to practitioners 
of the art, it contains practically nothing about anatomy 
and physiology. In his pathology he follows closely the 
teachings of the Methodists; his first question, in the 
presence of a case of illness, being: **Do the symptoms 
point to a condition of strictum rather than to one of laxum, 
or vice versa? ^^ **In his treatment," says Meyer-Steineg, 
'* Priscianus follows very closely the rule that every 
patient, no matter what may be the disease with which he 
is affected, should first undergo a certain amount of general 
treatment." In his choice of remedies Priscianus inva- 
riably gives the preference to those agents which are of 
a simple character and easy to obtain. On the other hand, 
he does not hesitate to admit that he sometimes employs 
certain magical remedies, as is shown by the following 
quotation taken from Book IV., Chapter I., section 4: — 

If a person wears, during the waning of the moon, a wreath of 
polygonum on his head, he will obtain relief from his headache. 

If one drinks of the water from which an ox has just 

drank, he will be relieved of the pain in his head If a 

loadstone be held upon the head it will draw out the hidden pain, 
and the same effect may be obtained by rubbing over the forehead 
a swallow's nest thoroughly mixed with vinegar. 

In Book I., paragraph 2, Priscianus draws a picture of 
the rude and uncivilized behavior of the practitioners of 
his day in the sick-room. The following are his words as 
translated from the German of Meyer-Steineg : — 

As the patient lies on his bed prostrated by the severity of the 
disease, there quickly comes into the room a crowd of us physi- 
cians. No feeling of sympathy for the sick man have we, nor do 



194 GROWTH OF MEDICINE 

we realize how impotent we all are in the presence of these forces 
of nature. Instead, we struggle to the utmost of our ability to 
obtain charge of the case ; one depending for success on his powers 
of persuasion, a second on the strength of the arguments which 
he is able to bring forward, a third on his readiness to agree with 
everything that is said, and the fourth on his skill in contradicting 
the opinion of everybody else. And, as this quarrel goes on, the 
patient continues to lie there in a state of exhaustion. "For 
shame!" Nature seems to say, "you men are an ungrateful lot! 
You do not even permit the patient to die quietly ; you simply kill 
him. And then, moreover, you accuse me of not furnishing suffi- 
cient means of effecting a cure. Illness is certainly a painful 
affair, but I have provided plenty of remedies. Poisons, I admit, 
are hidden in some of the plants, but the healing agents which may 
be extracted from them are much more numerous. Away, then, 
with your angry disputes and your self-glorifying chatter; for 
in these are not to be found the remedial agents which I have 
bestowed upon man, but rather in the powerful forces which reside 
in the seeds, fruits, plants and other objects which I have created 
in his interests." 

Aetius. — Aetius was a native of Amida, in Mesopotamia, 
and he lived during the early part of the sixth century 
A. D., under the Emperor Justinian I. He studied medicine 
at Alexandria and then settled in Constantinople, where 
he was appointed to the double office of private physician 
to the emperor and commanding officer of his body-guard 
{Comes obsequii), — an arrangement which made it prac- 
ticable for the emperor to have his physician near his 
person on all possible occasions. Almost nothing is known 
about the subsequent private life and professional career 
of Aetius beyond the facts that he was a Christian and that 
he wrote a treatise on medicine in sixteen books, which 
together form a large volume. The work, says Le Clerc, 
is almost entirely a compilation from the treatises of 
earlier writers on medicine and surgery; the best parts of 
the book being those which relate to the pathology and 
treatment of internal diseases, to materia medica, and to 
ophthalmology. The Christianity of Aetius, like that of 
Alexander of Tralles, and other physicians of a later 
period, appears to have permitted a belief in magical 



MEDICINE IN THE MIDDLE AGES 195 

remedies. For example, Aetius gives formulae containing 
the names of the Saviour and the Holy Martyrs for 
exorcising certain maladies, and he recommends the 
employment of amulets. The subject of baths is treated 
by him quite thoroughly, and he lays stress upon the 
importance of physical exercise as a means of maintaining 
one's health. Freind, the author of an English history of 
medicine which was very popular in its day,^ quotes the 
following remedy for gout from the treatise of Aetius: — 

In September to drink milk; 
in October to eat garlick; 
in November to abstain from bathing ; 
in December not to eat cabbage ; 

in January to take a glass of pure wine in the morning ; 
in February to eat no beet ; 

in March to mix sweet things both in eatables and drinkables ; 
in April not to eat horseradish ; 
nor in May the fish called Polypus ; 

in June to drink cold water ; — and so on through the remainder of 
the year. 

At the end of the French version of ^^Les Oeuvres de 
Rufus d' iSphese" (translated from the Greek by Darem- 
berg and Ruelle) will be found fragments of some of the 
books of Aetius; in 1899 J. Hirschberg translated into 
German Book VII. (eye diseases) of the same author; and, 
two years later (1901) Max Wegscheider published a 
German version of Book XVI. (obstetrics and gynaecology). 
No other translations of the writings of Aetius into either 
French, German or English are — so far as I am able to 
learn — available. 

Alexander of Tralles. — Alexander of Tralles, a city of 
Lydia, in Asia Minor, was bom about 525 A. D. His 
father Stephanus was highly esteemed as a practicing 
physician, and his four brothers, all of them older than 
himself, were men of distinction in their several callings; 
Anthemius, the oldest, being one of the greatest mathe- 
maticians and mechanicians of his day and the man to 

1 Third edition, London, 1726. 



196 GROWTH OF MEDICINE 

whom the Emperor Justinian intrusted the rebuilding of 
the church of St. Sophia in Constantinople;^ Metrodorus, 
a celebrated grammarian and the honored teacher of the 
youth belonging to the highest circles of that metropolis; 
Olympius, a leading authority in jurisprudence; and 
Dioscorus, a prominent physician in his native city. 
Alexander received his first instruction in medicine from 
his father, but he obtained his real training from a physi- 
cian who was the father of his most intimate friend Cosmas, 
and who, throughout Alexander's entire subsequent career, 
proved most helpful in advancing his interests. At first 
he traveled extensively, visiting in succession — probably 
in the capacity of a military surgeon — Italy, Northern 
Africa, Gaul and Spain. Afterward, he settled perma- 
nently at Rome and practiced medicine there during the 
remainder of a long life. Puschmann, the translator of 
his writings, seems disposed to believe that he was both 
a teacher and a practitioner of medicine during his resi- 
dence in that city. When he became too old to bear the 
heavy burdens of medical practice, he wrote an account of 
his life, — a life which was rich in professional experience, — 
and thus built for himself **a monument more striking and 
more durable than the splendid temple erected by his eldest 
brother." (Meyer, quoted by Puschmann.) 

Various circumstances justify the conclusion that Alex- 
ander of Tralles was a Christian. His style of writing 
is simple and direct, and he states his views with a degree 
of modesty which wins for him at once the sympathy and 
confidence of his readers. He gives full and generous 
recognition to the great physicians who lived and wrote 
before his time, and more especially to Hippocrates. On 
the other hand, he does not hesitate, when he believes that 
he is right, to put forward views which are in direct 
antagonism with those of even so great an authority as 
Galen. In the domain of therapeutics, says Puschmann, 
Alexander was decidedly superior to Galen. His teachings 

2 Anthemius is also credited with beiag the inventor of the principle of 
dome construction in architecture. 



MEDICINE IN THE MIDDLE AGES 197 

are based on experience gained in actual practice, whereas 
Galen was very often disposed to trust to considerations 
of a theoretical nature; for he was chiefly interested in 
establishing the pathology of the different diseases and in 
opening up new territories in medicine in which the human 
mind might display its activity. 

The twelve books of which the treatise of Alexander of 
Tralles consists, were printed in the original Greek for 
the first time in 1548, by Eobert ^fitienne, the celebrated 
printer of Francis L, King of France. The last and most 
perfect edition of the Greek text is that of the late Dr. 
Theodore Puschmann, which was published in Vienna in 
1878 (two Vols.). It contains, in addition to the Greek 
version, a careful analysis of the twelve individual books, 
and an admirable German translation of the entire work. 
It is from the latter that the following brief extracts 
(translated into English) are taken: — 

Introduction to the writings of Alexander of Tralles. — Upon 
a certain occasion, my dearest Cosmas, thou didst urge me to 
publish my rich experiences in the domain of practical medicine, 
and I am now gladly complying with thy wish, for I feel under 
deep obligations to both thyself and thy father for the kindness 
which you have shown to me on every possible occasion in the past. 
Thy father was always a most helpful patron to me, not only in 
my practice, but also in all other relations of life. And thou also, 
even when thou wert living abroad, stood staunchly by me through 
all the trials which I experienced and the severe blows dealt me by 
Fate. For these reasons I will now in my old age, when it is no 
longer possible for me to endure the labor and worries of practice, 
do as thou desirest, and will write a book in which shall be set 
forth the experience which I have gained during my long service 
in the treatment of disease. I hope that many of those who read 
what is here written, with minds free from jealousy, will experience 
real pleasure in noting the well-founded and scientific character 
of the rules which I have laid down and the brevity and preciseness 
of my descriptions. For I have done my very best always to 
employ simple words, in order that everybody may find it easy 
to understand my book. 

Some Magical Remedies or Amulets Recommended hy Alex- 
ander of Tralles, as Effective in the Treatment of Colic. — The 



198 GROWTH OF MEDICINE 

Thracians remove the heart from a lark while the bird is still alive, 
and wear it, prepared as an amulet, on the left thigh. 

Procure a little of the dung of a wolf, preferably some which 
contains small bits of bone, and pack it in a tube which the patient 
may easily wear as an amulet on his right arm, thigh, or hip during 
the attack. He must be very careful, however, not to allow the 
parts around the seat of the pain to come in contact with the earth 
or with the water of a bath. This amulet is, in my experience, an 
unfailing remedy, and almost all physicians of any celebrity have 
commended its virtues. 

Remove the nipple-like projection from the caecum of a young 
pig, mix myrrh with it, wrap it in the skin of a wolf or dog, and 
instruct the patient to wear it as an amulet during the waning of 
the moon. Striking effects may be looked for from this remedy. 

Let the design of Hercules throttling a lion be engraved upon 
a Median stone, and then instruct the patient to wear it on his 
finger after it has been properly set in a ring of gold. 

Take an iron ring and have the hoop made eight-sided. Then 
engrave upon the eighth side these words: "Flee, flee, oh Gaul! 
the lark has sought thee out." On the under surface of the 
head or seal of the ring engrave the letters J. C, thus: 
I have often made use of this amulet; and, while I should 
consider it wrong to keep silence about a remedial agent of 
such extraordinary efficacy in cases of colic, I feel bound to say 
that it should not be recommended to the first comer, but only to 
believers and to those individuals who know how to guard it 
carefully. The Great Hippocrates, with remarkable insight, gave 
the advice that things which are holy should be intrusted only to 
those who are of a religious character, and should be withheld from 
the profane. As regards the ring, however, the patient must be 
careful, before wearing it, to have a sketch made of it on either 
the seventeenth or the twenty-first day of the moon. 

Alexander has been severely criticised for his advocacy 
of the employment of amulets in the treatment of diseases ; 
but he defends himself against such criticism by saying that 
physicians owe it as a duty to their patients to study care- 
fully what he calls the hidden forces of nature, and to pay 
unprejudiced attention to the effects produced by amulets 
and other magical remedies. He reminds his critics that 
Galen and other eminent medical authorities have insisted 
that a place be given to this class of agents in the list of 



MEDICINE IN THE MIDDLE AGES 199 

authorized remedies; and lie adds that Galen further 
emphasizes the duty of the physician to employ them when 
other measures fail, or when the patients themselves 
frankly confess that they have faith in their efficacy and 
therefore wish them to be tried. Alexander also makes the 
statement that Galen, after treating for a long time all 
reports about the beneficial results obtained from the 
employment of magical measures as old women 's tales, had 
finally decided that these benefits were at times marvelous 
and should be accepted as genuine by physicians even if 
they are unable to explain them. 

How much Alexander of Tralles really believed in these 
supernatural agents, or to what extent he relied upon their 
effect in influencing the imagination, we may not know; 
but his was an age of superstition, and the conditions 
governing society at that time were very different from 
those which control the world at the present day. 

Paulus Aegineta. — Paulus Aegineta^ was born in the 
Island of Aegina, not far from Athens, in the early part of 
the seventh century A. D., and practiced medicine in 
Alexandria, Egypt. He is known to us as the author of a 
compend of medicine which was very popular during a long 
period of time, especially among the Arabs, who, as early 
as two hundred years after his death, translated his work 
from the Greek into their own language. At a still later 
period it was also translated into Latin, the two best ver- 
sions in this language which we now possess being those 
of Guintherus Andernacus (Paris, 1532) and of J. Cor- 
narius (Basel, 1556). There is also an English translation 
by F. Adams (''The Seven Books of Paulus Aegineta,*' 
London, 1845-1847), which is favorably spoken of by 
Neuburger, and which is apparently at the present time 
the only existing version of the work of Paulus of Aegina in 
a modern European language; for the French translation 
by Rene Brian (''La Chirurgie de Paul d'J^gine/' Paris, 
1855) comprises only Book VI. 

The contents of the entire work are as follows: 
Book I. — Dietetics of Pregnant Women and of Children; 

8 Also written Paulus Aeginetes. 



200 GROWTH OF MEDICINE 

Children's Diseases; Massage, Gymnastics, Sexual Hy- 
giene, Bathing, etc.; Booh //.^General Pathology, the 
Doctrine of Fevers, Semeiology; Booh III. — Diseases of 
the Hair, Diseases of the Brain and Nerves, Diseases of the 
Eyes, Ears, Nose, Mouth, Teeth and Face; Booh IV. — 
Leprosy, Skin Diseases, ^fnflammations. Swellings, Tumors, 
Wounds, Ulcers, Fistulae, Hemorrhage, Worms, Affections 
of the Joints, etc.; Booh V. — Toxicology; Booh VI. — Sur- 
gery; Booh VII. — Materia Medica. 

To furnish even a very superficial analysis of the contents 
of this treatise would call for more space than can well 
be given up here to such a purpose. I shall therefore 
simply mention a few points of special interest to which 
Neuburger calls attention in the course of his very full 
analysis of the work. He states, for example, that Paulus 
mentions several instances in which patients affected with 
lung disease, coughed up calculi or small stone-like masses. 
He also states that the same author was familiar with the 
fact that in the course of ''phthisis," the pus may find its 
way into the bladder and there cause ulceration [in other 
words, that pus containing tubercle baccilli may flow down 
by way of the ureters and cause tuberculous ulceration of 
the bladder]. Paulus' theory regarding the origin of gout, 
adds Neuburger, is quite remarkable for that early period. 
He maintains, for example, that in persons who lead a 
rather inactive life and who are often affected with 
digestive disorders, there is produced, through the inade- 
quate power of the tissues of the body to assimilate the 
excess of nutriment brought to them, a materies morbi 
which is drawn first to the parts that a're weakest or least 
capable of resistance (the joints, for example) and then 
also to other structures, as the liver, spleen, throat, ears 
and teeth. These ideas — let it be remembered — ^were set 
down in writing in 650 A. D. 

At the beginning of his analysis of Book VI., Neuburger 
makes this remark: ''Although the description given by 
Paulus of the surgery of the ancients is based upon the 
writings of Hippocrates and Galen, as well as upon those 
of Leonides, Soranus and Antyllus, one finds at every step 



MEDICINE IN THE MIDDLE AGES 201 

ample evidence that the writer possessed both independence 
of judgment and the manual skill which belongs to a physi- 
cian who is familiar with surgical work." He calls par- 
ticular attention to the section (No. 88) which deals with 
the manner of removing the heads of arrows from wounds, 
and he gives special praise to Paulus for his most instruc- 
tive account of the diagnostic signs to be looked for in a 
case of suspected wounding of a vital organ. He is 
extremely thorough, says Neuburger, in his teachings 
about fractures and dislocations, and he not infrequently 
differs from the views expressed by his predecessors. 

In the section devoted to gynaecological operations 
Paulus makes it perfectly clear that he was in the habit 
of using a speculum of a very practical form. Here are 
his words: — 

and, while the operator is holding the instrument in posi- 
tion, an assistant turns the screw until the blades of the instrument 
have been separated to the distance desired. 

In other chapters of Book VI., Paulus furnishes most 
interesting and minute descriptions of a great variety of 
operations in general surgery and also in obstetrics, 
ophthalmology, otology and rhinology. Those who desire 
to learn further details about these surgical matters should 
consult the English version mentioned on a previous page. 

It is not at all unlikely that at some future day it will 
be found desirable — by reason of the discovery of the 
treatises which they are known to have written, but which 
have been lost — to add to this short list of ancient medical 
authors the names of the following men who are frequently 
quoted by them in their works: Antyllus, who made some 
really valuable additions to our knowledge of the proper 
manner of treating aneurysms, and who must have been a 
surgeon of great resourcefulness; Leonides, the Alexan- 
drian, who lived about the time of Galen, and who appears 
to have been highly considered for his practical common 
sense in the choice of surgical measures; Hesychios of 
Byzantium and his distinguished son. Jacobus Psy- 
chrestus, who was highly spoken of by his contemporaries 



202 GROWTH OF MEDICINE 

(fifth century A. D.), in whose honor a public statue was 
erected (Haller), and to whom is attributed the saying: 
* * A good physician should either decline at the start to take 
charge of a patient, or else he should not leave him until 
he shall have brought about some measure of improve- 
ment"; finally, Heliodorus, and perhaps a few others who 
are less well known. 



CHAPTER XVIII 

BEGINNING OF THE ARAB RENAISSANCE UNDER 
THE CALIPHS OF BAGDAD 

Toward the end of the sixth century A. D. the prospects 
for the perpetuation and further evolution of Greek medi- 
cine looked decidedly dark. In Rome and in the larger 
Italian towns of the Roman Empire, physicians were 
doubtless still to be found, but they must have led very 
precarious lives and they certainly could not have had any 
leisure or opportunity for scientific work. In these earlier 
years of the Middle Ages the monks conducted the larger 
part of whatever medical practice was required in the 
districts in which the monasteries were located. In 
Byzantium, also, the outlook at this period of Roman his- 
tory was very unfavorable ; and nowhere else, as a matter 
of fact, would it have been possible for the casual observer 
to discover any signs that indicated the approach of a 
revival in the study of the sciences. And yet, even at that 
seemingly darkest moment in the history of medicine, there 
were forces at work which would soon revive these precious 
seeds of Greek knowledge, and, after transplanting them 
to a richer soil, cause them to produce even better fruit 
and in larger quantities than ever before. 

The rulers under whose auspices the first steps in the 
great Arab Renaissance were taken, belonged to what is 
known as the Abbaside Dynasty, the founder of which was 
Abbas (566-652 A. D.), the uncle of Mohammed. His 
descendants ruled as Caliphs of Bagdad, on the eastern 
bank of the Tigris, for many centuries (from 750 A. D. 
onward).^ Almansur, the second Caliph of this dynasty, 

1 The account which is given in this and the following chapters is based 
largely on Dr. Lucien Le Clerc's Histoire de la Medecine Arabe, Paris, 1876. 



204 GROWTH OF MEDICINE 

felt a very strong desire that his people, the Arabs, should 
acquire knowledge of all the useful branches of learning, 
and more especially of medicine and philosophy; and 
accordingly, as the Greeks were then universally admitted 
to be the only nation which possessed that knowledge, and 
as scarcely any scientific books written in the Arabic lan- 
guage existed at that early date, he directed all his efforts 
to the finding of Greek originals and of the men qualified 
to translate them into Arabic. Already as early as the 
sixth century A. D., Sergius, a Christian of Ras el Ain, had 
translated a considerable number of Greek treatises into 
the Syrian tongue, but his work was found to be of an 
inferior character, and for this reason could not be utilized 
to any great extent in the present undertaking. Honein 
(ninth century), one of the most eminent scholars of the 
Arabic Renaissance, revised a few of these translations 
and thus rendered them of some service; but by far the 
larger part of this gigantic task of creating Arabic versions 
of the classical works of Greek literature, was performed 
during the ninth century, a period during which the reign 
of the Arabs extended from the Ganges on the east to the 
Atlantic on the west. By the end of the eighth century the 
work of translating had advanced only to the point of 
producing a single treatise on medicine and a few relating 
to alchemy ; but before the ninth was completed, the Arabs 
had in their possession, in the form of translations, nearly 
all the scientific literature of Greece, and, more than this, 
they could boast that not a few men belonging to their own 
nation had already become celebrated as scientists of the 
very first rank. 

The medical school at Djondisabour^ at the time (765 
A. D.) when the Caliph Almansur decided to carry out the 
ambitious scheme which he had been meditating, was 
jjractically under the control of a family of Nestorian 
Christians. A large hospital formed the nucleus of the 
institution and furnished all the material needed for 
familiarizing the student with the different diseases and 

2 Le Clere and Freind mention both Nishapur and Djondisabour as the name 
of the capital of the Province of Khorassan in northeast Persia. 



TEE ARAB RENAISSANCE 205 

injuries commonly encountered in that part of the world 
and with the methods of treatment which, as long experience 
had shown, offered the best chances of affording relief or 
effecting a cure. It was a clinical school of a most practical 
type, and at the head of it was George Bakhtichou, who had 
been recommended to Almansur as the physician best fitted 
to take responsible charge of the new work which was then 
about to begin. George Bakhtichou was not the organizer 
of the school at Djondisabour, but simply its head at the 
time of which I am now speaking. Medicine had been 
taught there, it appears, since the early part of the seventh 
century A. D. The languages commonly spoken in that 
town were the Syrian, the Arabian and the Persian, and 
probably only a few persons understood Greek. The 
Caliph believed that, as the first and most important step 
in the new work, medical text books, translations of the 
works of the best Greek physicians, should be provided with 
as little loss of time as possible, and George Bakhtichou 
agreed with this opinion entirely. The latter, therefore, 
upon the urgent invitation of the Caliph, left the hospital 
at Djondisabour in the charge of his son, Bakhtichou ben 
Djordis, and went to Bagdad in company with two of his 
pupils, Ibrahim and Issa ben Chalata. He was well 
received at Court, partly because he displayed a readiness 
to further the Caliph's educational plans, and partly also 
because he was promptly successful in relieving him of a 
distressing dyspepsia. Not long after he had arrived in 
Bagdad, however, he was himself taken ill and was obliged 
to return to Djondisabour. Before his departure the 
Caliph presented him with a gift of 10,000 pieces of gold. 
Issa ben Chalata, one of the two pupils whom George 
Bakhtichou had brought with him to Bagdad, was left 
behind to look after the Caliph's health. He proved 
faithless to his trust, however; and, as soon as it was 
discovered that he was selling his supposed influence with 
the Caliph, he was not only dismissed in disgrace but all 
his property was confiscated. After this disagreeable 
experience the Caliph did his best to induce George to 
return to Court, but the latter was then unable to travel, 



206 GROWTH OF MEDICINE 

owing to the injuries which he had received from an acci- 
dental fall. His pupil Ibrahim went to Bagdad in his 
place. 

It is known that George Bakhtichou personally took an 
active part in the work of translating Greek medical 
treatises into Arabic, but it has not yet been ascertained 
which books in particular were assigned to his care in the 
distribution of the different tasks. Ossaibiah, the Arabian 
historian, makes the statement that the work of translating 
Greek medical treatises was entirely under the control and 
guidance of George Bakhtichou; and in the '^Continens" 
of Rhazes frequent mention is made of the latter 's name. 
All of which confirms the belief that, at the beginning of 
the Arabic Renaissance, George Bakhtichou was in reality 
the head and front of the movement, so far at least as 
medicine was concerned. When he became too old and 
infirm to continue his attendance at the Djondisabour 
hospital, he intrusted the management of that institution 
to Issa ben Thaherbakht, who was one of his best pupils. 
He died in 771 A. D. 

In 786 A. D., Haroun Alraschid succeeded to the 
caliphate ; and not long afterward, on the occasion of some 
temporary illness, he requested Bakhtichou ben Djordis, 
the son of George and his successor in the work of trans- 
lating from the Greek, to consult with the regularly 
appointed physicians of the Court in regard to the nature 
and proper treatment of his malady. The consultation 
took place at the appointed time, and one of the Caliph's 
physicians, thinking that he might catch Bakhtichou in a 
trap, submitted to him a specimen of urine which purported 
to come from the Caliph, but which in reality had been 
obtained from a beast of burden. Alraschid, who knew of 
the deception, asked: — 

''What remedy would you administer to the person from 
whom this urine came ? ' ' 

Bakhtichou, who had been clever enough to recognize the 
true character of the specimen, replied promptly : ' ' Some 
oats, your Majesty." 

The Caliph laughed heartily over the episode, loaded 



THE ARAB RENAISSANCE 207 

George's son with presents, and appointed him the chief 
of all his physicians, — the first instance among the Ara- 
bians, it is said, of the appointment of an Archiater. 

Bakhtichou ben Djordis was the author of a collection 
of short medical treatises, and he also wrote, for the special 
use of his son Gabriel, a medical ** remembrancer. " He 
was as highly esteemed by the Arabs as his father had been 
before him. The date of his death is not known. 

Gabriel, the son of Bakhtichou and a grandson of the 
famous George Bakhtichou, was the most distinguished 
member of this remarkable family of physicians. In the 
year 792 A. D., five years after the consultation mentioned 
above had taken place, Gabriel was sent by his father to 
give medical advice to Jafar, the son of the Grand Vizier. 
The treatment which he recommended proved to be entirely 
successful, and, pleased with the result, Jafar soon after- 
ward had an opportunity to speak to Haroun Alraschid 
of Gabriel as the physician best fitted to effect a cure in 
the case of his own favorite wife, who, in a fit of yawning, 
had dislocated her shoulder. The Arabian physician had 
tried friction, different sorts of ointments, and manipu- 
lations of every imaginable kind, but all in vain. The 
dislocation still persisted. When Gabriel arrived on the 
scene he told the Caliph that he could bring the shoulder 
back into place provided no offense would be taken at the 
means which he was about to employ. Alraschid gave the 
desired promise and Gabriel made a movement as if he 
were about to lift up the bed-clothes. Instantly the patient, 
through a natural sense of modesty, stretched out her 
dislocated arm to keep the bed-covering in place. * * There ! 
she is cured ! ' ' exclaimed Gabriel, and such indeed was the 
truth. The sudden movement of the limb had reduced the 
dislocation. — It only remains for me to add that the sum 
of 500,000 drachmae^ was paid to Gabriel by Haroun 
Alraschid for his successful treatment. 

Some surprise having been expressed by the Caliph *s 

3 The drachma was a silver coin worth about 9% pence English money. The 
fee paid to Gabriel for his surgical services amounted, therefore, to a little less 
than £2000 or $10,000. 



208 GROWTH OF MEDICINE 

relatives that he should display such extravagant gener- 
osity toward a Christian, he replied: ''The fate of the 
empire is bound up in my fate, and my life is in the hands 
of Gabriel." 

Gabriel Bakhtichou died in the early part of the ninth 
century, not long after the Caliph El Mamoun had started 
on his expedition against the Greeks (828 A. D.). He was 
the author of several medical treatises, and, like his famous 
grandfather, George Bakhtichou, he did everything in his 
power to promote the work of translating from the Greek 
into the Arabic. Gabriel's brother, also named George, 
and his son Bakhtichou ben Djabriel were both of them 
physicians of considerable distinction. The latter accom- 
panied El Mamoun on his expedition against the Greeks. 
It is a fact worth noting here, that throughout this war 
the Caliph never for a moment lost sight of the great 
national scheme of education which his predecessor 
Almansur had inaugurated and which was still engaging 
the time and best efforts of many scholars and copyists in 
Bagdad. Whenever he captured a city he insisted upon 
the delivery to him of whatever copies of scientific treatises 
its citizens might possess. But even these extraordinary 
methods of securing the books which they needed did not 
satisfy the Arabs, their eagerness to accumulate as many 
text books as possible being insatiable. Accordingly, from 
time to time, one of the translators — some member of the 
Bakhtichou family, for example — ^would be sent to the 
different cities of Syria and Persia to search out and get 
possession of as many Greek manuscripts as possible. 
Thus, Honein is reported to have said : ' ' I have not been 
able to procure a complete copy of Galen 's * Demonstration. ' 
Gabriel endeavored to find a copy, but did not succeed ; and 
I myself hunted through Irak, Syria, Palestine and Egypt, 
but was at last only partially successful. I found one-half 
of the text in Damascus." 

The work of translation was kept up with unremitting 
zeal until the middle of the ninth century (reigns of El 
Ouatocq and of Moutaouakkel). 

Among the physicians who received their training at the 



TEE ARAB RENAISSANCE 209 

Djondisabour medical school the Bakhtichous were not the 
only ones who attained considerable distinction. John 
Mesne the Elder,* for example, who was a Nestorian 
Christian and the son of an apothecary, became more 
famous than any member of that family. He not only did 
his full share of the translating, but he was also a prolific 
author and a very faithful and efficient teacher, Galen's 
writings furnishing the basis of his lectures. He lived to 
be about eighty years of age, his death occurring in 857 
A. D. Most of his writings have been lost. Of the twenty 
or more which have come down to our time those bearing 
the following titles deserve to receive special mention: — 

Book of Fevers. 

On the Different kinds of Food and Drink. 

On Venesection and Scarifications. 

On Tubercular Leprosy. 

On Abnormal Prominence of the Abdomen. 

On Purgative Remedies. 

On Baths. 

On the Regulation of Diet. 

On Poisons and Poisoning. 

On Vertigo. 

On the Treatment of Sterility. 

On Dentifrices and Gargles. 

Sabour ben Sahl, whose death occurred in 869 A. D., was 
also connected with the hospital at Djondisabour. He was 
distinguished on account of his special knowledge of the 
properties of simple drugs and their combinations. He 
was also the author of the exhaustive formulary known as 
Acrahadin Kehir — probably the first one of its kind, says 
Le Clerc, of which history makes any mention. This 
formulary or dispensatory — of which a large and a small 
edition existed — was in general use in all the hospitals, 
physicians' offices, etc., of that time. 

Still another most distinguished physician and author of 
medical treatises received his training at the Djondisabour 

4 To distinguish him from Mesufi the Younger, who lived at Cairo, Egypt, 
ahout one hundred years later, and who attained considerable celebrity on 
account of the treatises which he wrote on materia mediea. 



210 GROWTH OF MEDICINE 

school — viz., John, son of Serapion (or Serapion the Elder, 
as he is commonly called). He lived about the middle of 
the ninth century of the Christian era and wrote entirely 
in the Syrian language, but at a later date his works were 
all translated into Arabic. The smaller of his two most 
important treatises, and at the same time the one which 
appears to have attracted the most attention, was called 
the Kounnach. About the middle of the twelfth century 
A. D. it was translated into Latin by Gerard of Cremona, 
and named by him Breviarium; a still later translation 
received the name of Practica. The first part of this 
smaller treatise (the Breviarium or the Practica) is 
divided into six books, the titles of which are as follows : — 

1. On Nodosities, Ophiasis, and Alopecia. 

2. On the Falling Out of the Eyelashes. 

3. On the Mild Form of Tinea, the form which resembles Favus. 

4. Scaly Affections of the Head and of Other Parts of the Skin. 

5. Lice of the Head and of the Body. 

6. Headache caused by Exposure to the Sun; and other forms 
of Cephalalgia. 

Salmouih ben Bayan, a Christian, was the last one of 
the pupils of the Djondisabour school who attained con- 
siderable celebrity as a physician. When the Caliph 
Motassem came to the throne in 833 A. D., he appointed 
Salmouih his personal physician and soon became very 
much attached to him; leaning upon him more and more 
for advice in all sorts of troubles. Salmouih was the author 
of several medical treatises, but they have all been lost, 
not even their titles are now known to us. When dying 
(early in 840 A. D.), he sent word to the Caliph not to put 
his entire trust in the medical judgment of Mesne if he 
should find it necessary to call upon the latter for advice 
in the event of a serious attack of illness. This celebrated 
physician was universally admitted to be most learned in 
everything relating to medicine, but there were many of 
his professional brethren — and Salmouih was among the 
number — who did not esteem him so highly as a practitioner. 
''The most important thing in medicine," said the latter, 



THE ARAB RENAISSANCE 211 

*'is to appreciate correctly the intensity of the disease, and 
that is something which Mesne, with all his learning, is not 
able to do." However, despite the death-bed warning 
given by Salmouih to Motassem, this ruler died less than 
two years later from the effects of the treatment which 
Mesne the Elder, who had been called in to prescribe for 
his Highness, had ordered. 

In addition to the pupils already mentioned there are a 
few others who, according to the testimony of Le Clerc, 
reflected some credit upon the institution in which they 
acquired their medical training. But enough has already 
been said, I believe, to establish the fact that, in this remote 
Persian province of Khorassan (to the west of the country 
known to-day as Afghanistan), there existed during the 
eighth and ninth centuries of the present era a most 
efficient medical school, which was entirely managed by 
Nestorian Christians, and which sent out into the world 
trained physicians of the very highest type. 



CHAPTER XIX 

FURTHER ADVANCE OF THE ARAB RENAISSANCE 
DURING THE NINTH AND SUCCEEDING CEN- 
TURIES OF THE CHRISTIAN ERA 

During the latter part of the eighth century the Arab 
Renaissance, so far at least as the science of medicine 
was concerned, was controlled and kept in vigorous life 
almost entirely by physicians who were connected with the 
school at Djondisabour — one might almost say, by physi- 
cians who were members of the Bakhtichou family. To 
this family, therefore, belongs the chief credit for the 
admirable results attained during this, the first stage of 
the Renaissance. But during the ninth century A. D. men 
who had not received their professional training at this 
famous school came to the fore and gave a fresh and a more 
vigorous impulse to the work than their predecessors had 
given. Under the Bakhtichous the translating had been 
well started, and in addition a few original medical treatises 
had been written in the Arabic language. During the 
period which followed, however, the translating and copying 
became more active than before, and, in addition, several 
really valuable treatises were produced by men who wrote 
in Arabic, and who were — if not racially Arabs — at least 
the adopted sons of that nation. Of these men none stands 
out more prominently than Honein, who, according to 
Le Clerc, ** accomplished a marvellous amount of work of 
the most varied character and of a very high degree of 
excellence, and that too despite many obstacles. While 
he was not the originator of the Renaissance in the East, 
he took the most active part in keeping it up." 

Honein, who may rightly be considered as having at 
least inaugurated the second stage of the Arab Renais- 



THE ARAB RENAISSANCE 213 

sance, was born in 809 A. D. at Hira, where his father 
Isaac, a Christian Arab, conducted a pharmacy. The 
inhabitants of this town were known to be somewhat 
lacking in cultivation, and it was therefore not surprising 
that, when Honein went to Bagdad and presented himself 
to John, the son of Mesue, as one who wished to become his 
pupil, his request was promptly declined on the general 
ground that the people of Hira had not received sufficient 
education to warrant any one of their number in under- 
taking the study of medicine. This decision was of course 
a great disappointment to Honein, but it disturbed him 
only for a short time. Soon afterward he went to Greece 
where he worked hard to perfect himself in the knowledge 
of the Greek language. Then, after a residence of two 
years in that country, he returned to Bagdad, taking with 
him a considerable supply of Greek books. His next step 
was directed toward gaining a better knowledge of Arabic, 
iand with this object in view he spent some time in Bassora, 
a town which was situated not far to the south of Bagdad, 
and which possessed good educational facilities. While 
residing there he devoted a certain portion of his time to 
the translation of Galen 's treatise on anatomy ; and he was 
accordingly prepared, upon his return to Bagdad, to sub- 
mit to John, the son of Mesne, and to Gabriel, the son of 
Bakhtichou (who by that time was well advanced in years), 
a specimen of the work upon which he had been engaged. 
Both of these men were greatly pleased with the excellence 
of the translation, and encouraged Honein to go on with 
the work. El Mamoun (the second son of Haroun Alras- 
chid), who was the then reigning Caliph, engaged his 
services both as a translator of Greek writings (into Syriac 
as well as Arabic) and as a reviser of the translations 
which had been made by others, and he paid him most 
generously for these services. According to Le Clerc, the 
amount of literary work done by Honein was simply 
prodigious. He translated large portions of the treatises 
of Galen, Oribasius and Paulus Aegineta, as well as several 
of the works of Aristotle and of Plato, of the mathema- 
ticians and astronomers, and also of the philosophers ; and 



214 GROWTH OF MEDICINE 

in addition he wrote a large number of original treatises — 
such, for example, as a complete set of commentaries on 
the writings of Hippocrates, a practical work on the 
diseases of the eyes, etc. 

The following account of Honein's experience at the 
Court of the Caliph Moutaouakkel (middle of the ninth 
century A. D.) furnishes some insight into his character: — 

The Caliph, who had heard of the great learning, ability, and 
industry of Honein, but who had at the same time feared that he 
might be in secret communication with the Greeks, decided to 
subject him to a test that would reveal how far he was venal. 
Accordingly he sent for him, clothed him in robes of honor, gave 
him 50,000 drachmae, and then said: 

*'I wish that thou wouldst prepare for me a secret combination 
of drugs which will enable me to get rid of one of my enemies. ' ' 

Honein replied: ''I have no knowledge of any but salutary 
remedies, and it never occurred to me that the Prince of Believers 
might ask me to furnish those of a different kind. However, if it 
be the wish of your Majesty, I will see what I can do ; but I shall 
require plenty of time." 

After waiting in vain for the desired preparation and finding 
that even threats failed to accomplish anything*, the Caliph put 
Honein in prison. Then, at the end of a year, which interval the 
latter had employed diligently in the work of translating, 
Moutaouakkel gave orders for the prisoner to be brought into his 
presence. Before this was done, however, a heap of objects of 
value was placed on one side of the room and instruments of 
torture on the other. When Honein was brought in, the Caliph 
said to him : ' ' Time is passing, and my wishes have not yet been 
gratified. If thou art now ready to obey my behest, these treasures 
and many others in addition shall be thine. But, if thou continuest 
to refuse, I will subject thee to tortures and will finally put thee 
to death." 

"I have already told the Prince of Believers," replied Honein, 
"that my knowledge is limited to the preparation of salutary 
remedies. ' ' 

Whereupon the Caliph said: "Have no fear! I simply wished 
to test thee! But tell me, what are the reasons upon which thy 
refusal is based?" 

' ' There are two reasons, ' ' replied Honein : * * my religion and my 
profession. The first teaches us to do good to our enemies; and 



THE ARAB RENAISSANCE 215 

the second, not to do any harm to the human race. Every physician 
has registered an oath that he will never administer a poison." 

"Those are two excellent laws," remarked the Caliph; and he 
proceeded to load Honein with presents. 

Among those who were associated with Honein in his 
work of translating Greek medical books into Arabic there 
are three whose names also deserve to be remembered. 
They are : his son Isaac ; his nephew Hobeich ; and a Chris- 
tian Greek named Costa ben Luca, whose residence was at 
Baalbek. To men of the present time all these names of 
oriental physicians are, as a rule, mere meaningless words, 
conveying no idea of an important relationship to the 
evolution of medicine. During the ninth and tenth cen- 
turies of the present era, however, and indeed for many 
years subsequent to that time, they were accorded by the 
physicians of that period almost as much honor for the 
part which they took in furthering the revival of medicine 
among the Arabs as was given to Honein himself. It seems 
therefore appropriate that at least a brief account of the 
lives of these men and of the work which they did should 
be given here. . 

Isaac received his education from his father Honein, and 
soon after reaching manhood he was set to work trans- 
lating from the Greek into both Syrian and Arabic — two 
sister languages. He was a man of great intelligence, and 
was thought by many to be the equal of his father in the 
knowledge of Greek, Syriac and Arabic. He also had, like 
his father, the good fortune to find favor with the rulers 
of that period. He died in 912 A. D. as the result of a 
stroke of cerebral apoplexy. In addition to his trans- 
lations he wrote original treatises on the following topics : — 

Simple Medicaments. 

Origins of Medicine. 

Correctives of Purgative Remedies. 

Treatment by Cutting Instruments. 

The means of Preserving the Health and the Memory. 

Hobeich was the son of Honein 's sister. The date of his 
birth is not known. He received his training in the Ian- 



216 GROWTH OF MEDICINE 

guages from Ms uncle, and in the course of time became 
associated with the latter in the work of translating. 
Eventually he reached his uncle 's high standard of scholar- 
ship, and the text of his translations was from that time 
forth accepted without any revision. The Caliph Mou- 
taouakkel appointed him Court Physician, and the imme- 
diate successors of this Caliph retained him in the same 
position. His death occurred during the second half of 
the ninth century of the Christian era. 

Hobe'ich translated the ''Oath of Hippocrates" and a 
large number of the more important of Galen's treatises. 
In addition, he left to posterity several original writings. 
Quotations from these are to be found in the works of 
Rhazes, of Ebn el Beithar, and of Serapion the Younger, 
and they reveal two important facts: first, that Hobeich 
was an excellent practicing physician ; and, second, that the 
Arabs had already at this comparatively early date begun 
to gather their medical information from other sources 
than the Greek treatises. The following drugs, for 
example, are described by Hobeich in the quotations just 
mentioned, and yet they do not appear to have been known 
to the Greek medical writers : Turbith, Convolvulus of the 
Nile, Nux Vomica, Colocynth, Croton Tiglium, Aloes and 
Myrobolans. 

Costa, the son of Luca, was a Christian Greek from 
Baalbek, in Syria. The dates of his birth and death are 
not known, but it is believed that he lived during the first 
half of the tenth century of the present era. He was an 
excellent Greek and Arabic scholar and was also familiar 
with the Syriac language. His translations were esteemed 
equal to those of Honein. After spending some time in 
Greece he settled in Irak, a province of Persia, and devoted 
himself to the translation of the books which he had 
brought with him from Greece. At a later period of his 
life he removed to Armenia, a country which lies to the 
north of Irak, between it and the Black Sea, and it was 
during his residence there that he wrote a number of 
treatises. It was in Armenia, also, so far as may be judged 
from the accounts which we possess, that his death took 



THE ARAB RENAISSANCE 217 

place. As an evidence of the fact that he was highly 
esteemed by his contemporaries, his biographer states that 
a cupola was built over his tomb. 

Among the medical works which he translated from the 
Greek the following are the only ones of special impor- 
tance: The Aphorisms of Hippocrates, and Galen's com- 
mentaries upon them. 

The ninth century, the period during which the major 
portion of the work described in the preceding part of this 
chapter was accomplished, is considered by Lucien Le Clerc 
the most remarkable in the world's history. He speaks of 
it in the following terms : — 

Its greatness is emphasized by the fact that, except in this one 

corner of the globe, everything was in a state of decadence 

Great as is the credit due the Abbaside Djmasty and its ministers, 
still greater is our admiration for the Arab nation on account of 
the eagerness with which it met the wishes of its rulers and also 
because it pursued resolutely, and despite all the obstacles 
(political and religious) which were placed in its way, the course 

laid down for it to follow The Arabs also knew how to 

choose men who were really eminent and to rescue them from lives 
which otherwise would probably have been sterile; they claimed 
the inheritance of Greek science; and they revealed to the world 
that they were worthy of this inheritance. 

Some idea of the completeness of the list of Greek 
medical works which the Arabs translated may be gained 
from the fact that Galen's writings are more complete in 
the Arabic than they are in the Greek, the language in 
which they were originally composed. 

With Costa the second stage in the Arab Renaissance 
came to an end. All the work accomplished at Bagdad 
up to this period in our history received its inspiration 
from the different Caliphs belonging to the Abbaside 
Dynasty. But now the political conditions in the East 
underwent a change, and other Arabian dynasties, each in 
its turn, gained control of the power previously wielded 
by Almansur, Haroun Alraschid and their successors. 
Fortunately, all of these new rulers seem to have been 
favorably inclined toward the revival of literature, and 



218 GROWTH OF MEDICINE 

consequently the Arabs continued to take an active part 
in the advance of medical knowledge during the tenth and 
eleventh centuries. Bagdad, however, ceased to be the 
centre of all this intellectual activity, and eventually 
Cordova in Spain almost rivaled the capital of ancient 
Greece in the eagerness with which she sought to increase 
her stores of books, and in her readiness to honor scholars. 
By this time the Arabs controlled, not only Persia and 
Arabia, but also Egypt, Palestine, Syria, Marseilles, the 
coast of Asia Minor, Greece, Sicily, the northern part of 
Africa and Spain. Owing to the limited space at my 
command I shall be obliged to confine my account to the 
more salient features of the progress made during this 
later or third stage of the Arab Eenaissance. 

Already as early as toward the end of the ninth century 
the number of physicians in the East had increased so 
greatly, and the territory where well-educated medical men 
were to be found had broadened to such an extent, that I 
shall now be obliged, in order to maintain some approach 
to chronological order in my account of the evolution of 
medical science, to treat the subject according to countries. 
If the men who stand out foremost in this third stage of 
the scientific renaissance are not in every instance Arabs 
or Persians or Syrians, I may at least claim that they are 
the product, directly or indirectly, of the great Arab move- 
ment. The countries in w^hich their best work was done 
are the following: Persia (apart from Bagdad and its 
immediate neighborhood), Egypt, Magreb (the modern 
Algiers and Tunis ) , Fez and Spain. But, before I consider 
the progress of medicine in these different parts of the 
Orient, I should say at least a few words about the events 
which characterized the cessation of literary work at 
Bagdad. As might be expected, that city, after the Greek 
medical and scientific treatises had all been translated 
into Arabic, gradually lost its pre-eminence as a centre of 
learning, and new centres developed in other cities through- 
out the vast Musulman Empire. It must not be inferred, 
however, that this change was wholly or even largely due 
to the cessation of literary work. Other factors contributed 



THE ARAB RENAISSANCE 219 

to this result, viz. : the decadence of the caliphate and the 
fact that the caliphs themselves appeared to lose their 
interest in promoting the sciences actively. It was not 
until during the tenth century that any further interest 
in the advancement of medical science was taken by those 
in authority at Bagdad. Then the Emir Adhad Eddoula 
built a splendid hospital, and organized it on the basis of 
several separate services — one for fever cases, another for 
accidental injuries, a third for ophthalmic cases, and so on. 
Twenty-four physicians, who had been selected because of 
their special aptitude for some particular class of medical 
work, were appointed to take charge of the diiferent ser- 
vices ; and it is interesting to note that nearly all of these 
men bear Arab names. Nevertheless, for a still further 
period of many years, says Le Clerc, there continued to be 
as many Christian as Mohammedan physicians in Bagdad. 

In the tenth century other hospitals were established in 
Bagdad. Thus, in 914 A. D., the Vizir Ali ben Issa founded 
one which he endowed in the most liberal manner. This 
Vizir must have been a most humane person, for, when 
the physician-in-charge wrote to him for further instruc- 
tions regarding the course which he should pursue mth 
respect to people of different religions, the Vizir replied: 
*'Use the fund for the benefit of all classes alike, and be 
sure to remember the animals." 

Persia. — Ehazes, whose full name is Abou Beer Moham- 
med ben Zakarya, is generally admitted to have been the 
most illustrious of Persia's physicians, and probably the 
most distinguished representative of Arab medical learn- 
ing. He was born at Raj, in the Province of Khorassan, 
about 850 A. D. After he had received his professional 
training at Bagdad, he settled at Raj and was soon after- 
ward appointed director of the local hospital. At a later 
date he was placed in charge of the hospital at Bagdad, 
but before many months had elapsed he returned to Raj, 
his native town, and here he spent most of the remaining 
years of his long life. The date of his death is stated by 
Haeser as either 923 or 932 A. D., but Le Clerc mentions 
only the latter date. 



220 GROWTH OF MEDICINE 

Ehazes was a very hard worker and was Mghly esteemed 
by his fellow countrymen, who called him the Arabian 
Galen. The total number of writings which he left behind 
him at the time of his death was 237, most of them dealing 
with medical subjects. A few of them, however, were de- 
voted to the discussion of chemical, anatomical and philo- 
sophical questions. To-day we possess only 36 of the 
treatises written by Rhazes, and of this number only six 
have been printed in Latin. His greatest work, as all 
critics admit, is that which is commonly known as the 
''Continens" (or **E1 Haouy")- In this work, which is 
divided into twenty-two books, Rhazes gives in a con- 
densed form the views entertained by all his predecessors 
regarding the more important questions in medical science, 
and then adds thereto the conclusions which his own expe- 
rience has led him to form. 

He also wrote a second treatise (in ten books) which 
was esteemed by the physicians of that and later periods 
almost as highly as the Continens. It was called the '*Man- 
soury," and its contents are distributed as follows: I., 
Anatomy; II., the Different Temperaments; III., Alimen- 
tary Substances and Drugs; IV., Hygiene; V., Cosmetics; 
VI., the Regimen to be adopted in Traveling; VII., Sur- 
gery; VIIL, Poisons; IX., Maladies in General; X., Fevers. 

A third treatise of considerable importance is that which 
is devoted by Rhazes to the description and treatment of 
small-pox and measles. So far as is known at the present 
time this is the first treatise that has been written on these 
diseases, and its celebrity rests, not only upon this cir- 
cumstance, but also upon the facts that its author is evi- 
dently familiar with the different types of small-pox and 
with the characteristic features which distinguish this dis- 
ease from measles. Freind, in commenting upon this 
treatise, says that Rhazes assigned for small-pox a cause 
"entirely new in physick, a sort of an innate contagion. 
This is a ferment in the blood, like that in must, which 
purifies itself sooner or later by throwing off the peccant 
matter at the glands of the skin; an hypothesis since ap- 
plied, though upon very slight grounds, to feavers in gen- 



THE ARAB RENAISSANCE 221 

eral by many moderns." From this account it is fair to 
conclude that Ehazes, in the tenth century of the Christian 
era, as clearly suspected the germ origin of certain febrile 
diseases as Liebermeister did toward the end of the nine- 
teenth, or as Fracastoro did in the sixteenth. And one can- 
not help exclaiming: How many centuries had to elapse, 
and what an immense amount of other facts had still to 
be discovered — facts in anatomy, in physiology, in chem- 
istry, in optics, etc. — before it became possible to convert 
this suspicion, this simple product of the reasoning faculty, 
into an actual demonstration of the truth in pathology! 

Among the Arabian physicians of the eleventh century 
Avicenna is certainly one who should be placed in the first 
rank. He was born in 980 A. D. at Afschena, a village in 
the Province of Khorassan, Persia, and spent his youth 
in Bokhara, where his father held some high office under 
the Government. His great intellectual capacity was re- 
vealed at an early age. It is said, for example, that already 
before he was ten years old he had committed the entire 
Koran to memory; and it is added, further, that when he 
was only seventeen years old he had already acquired such 
knowledge of medicine that he was invited to take part in 
a consultation regarding some malady with which the Emir 
Nuch ben Mansur was affected. The advice which he gave 
on this occasion was followed, and in the sequel it proved 
so good that he was granted, as a reward, unrestricted 
access to the royal library, — a privilege which he utilized 
to the very best advantage. When his father died Avicenna 
came into possession of a large fortune, which enabled him 
to indulge in a great deal of traveling. In this way he 
visited one Persian Court after another throughout a 
period of several years. Finally, during a residence at 
Hamadan, the Prince Schems ed-Daula, whom Avicenna 
had successfully treated for some malady, made him his 
Vizir. While he held this office he managed, without 
neglecting his official duties, to continue his scientific 
studies ; but he was not able entirely to keep out of political 
intrigues, and as a consequence his life was for a short 
time in some danger. He was confined for several months 



222 GROWTH OF MEDICINE 

in a fortress, from whicli, however, he managed eventually 
to make his escape to the Court of Ibn Kakujah, in Ispahan. 
He resided in that city during the following fourteen years, 
and it was there that he wrote his two principal works — 
the famous medical treatise known as the *' Canon," and 
the equally celebrated cyclopaedic work on philosophy. 
Worn out by his incessant and most exhausting literary 
labors and by his excesses in other directions, Avicenna 
died in June, 1037 A. D., while he was accompanying the 
Emir on his expedition to Hamadan. His tomb may still 
be seen in the latter city. 

Neuburger, from whose excellent History of Medicine 
the preceding details have been gleaned, makes the state- 
ment that the treatise in which Avicenna 's clinical expe- 
rience was recorded has not come down to our time, and 
that, consequently, we lack the means of estimating just 
how great a physician — just how close a clinical observer 
and how wise a practitioner — he really was. So far, how- 
ever, as may be judged from the evidence furnished by the 
Canon, Avicenna was not the equal, in all practical matters 
relating to medicine, of Haly Abbas and of Rhazes. He 
was perhaps too much inclined to '4ook at bedside phe- 
nomena through the spectacles of preconceived theories.'* 
In brief, he was, first and foremost, a philosopher, and only 
in a subordinate degree a physician, although a most excel- 
lent one. In Book IIL, where he discusses certain surgical 
procedures, statements are made which justify the belief 
that Avicenna was acquainted with intubation of the larynx. 

Le Clerc mentions six other Persians who, during the 
tenth century of the present era, gained more or less dis- 
tinction as physicians. In the following paragraphs brief 
notices are given of each of these men. 

Eben el Khammar, born in 942 A. D., was a Christian 
and an excellent practitioner. He was well versed in the 
science of medicine and a writer of some importance. Date 
of death unknown. 

Abou Sahl el Messihy, who was also a Christian, was a 
contemporary and intimate friend of Avicenna. He died 
in 1000 A. D. He was the author of a complete and very 



THE ARAB RENAISSANCE 223 

useful summary of medicine, entitled ''Kitab el Meya"; 
and the Arab historian Ossaibiah speaks in terms of ad- 
miration of another treatise which he wrote and which 
bears the title, '* Exposition of God's wisdom as Mani- 
fested in the Creation of Man." 

Abou Soleiman Essedjestany, commonly called '*E1 
Mantaky." The dates of his birth and death are not 
known. He wrote a number of treatises, and — among 
others — one on ''The Organization of the Human Facul- 
ties." 

Aboul Hassan Ahmed Etthabary, a native of Thabaris- 
tan, in the Province of Khorassan. He was employed as 
a physician by the Emir Rokn eddoula ben Bou'ih, and is 
known as the author of a compendium of medicine entitled : 
''Hippocratic Methods of Treatment." He died in 970 
A. D. 

El Comry was one of the most eminent medical prac- 
titioners of his time, and was in high favor with the royal 
household. He wrote a compendium of medicine which 
bears the title ''R'any ou Many," and he was also the 
author of a treatise on the causes of disease. His death 
occurred toward the end of the tenth century of the Chris- 
tian era. 

Alfaraby, who is highly commended by Avicenna, should 
be classed among the philosophers rather than among the 
physicians. He died in 950 A. D. 

The sixth Persian physician of some distinction men- 
tioned by Le Clerc is Ali ben el Abbas — usually spoken of 
as Haly Abbas. The dates of his birth and death are not 
stated by any of the authorities, but it is known that he 
was a native of Ahouaz, a small town on the Karun river, 
to the southeast of Bagdad, and that he was still living 
in 994 A. D. Haly Abbas, it is claimed, was the first med- 
ical writer who ventured to prepare a complete and sys- 
tematically arranged Practice of Medicine. He gave it the 
title of Al-Maleky — ''The Royal Book," — and dedicated it 
to the Emir Adhad-ad-Daula, whose private physician he 
was. It is a much smaller treatise than the "Continens" 
of Rhazes, and somewhat more complete than the same 



224 GROWTH OF MEDICINE 

author's shorter work — the * ' Mansoury. ' * It covers the 
entire field of medicine and is distinguished by its very 
practical character. It was first translated into Latin in 
1127 A. D. X\ 

Haly Abbas, in one of ms treatises, speaks of Hip- 
pocrates in the following terms : * * Hippocrates, who is the 
prince of the medical art and the first physician who ever 
wrote a book on this art, is the author of many treatises 
on all sorts of medical topics .... But he writes in such 
a very concise manner that much of what he says is ob- 
scure, and as a consequence the reader, if he wishes to 
understand him, is obliged to seek the aid of a commen- 
tary. ' ' 

Egypt. — The dynasty of the Fatimides — the descendants 
of Fatima (the daughter of Mohammed) and of Ismael, a 
great-grandson of Ali, the fourth of Mohammed's succes- 
sors — reigned over Egypt for nearly two centuries (10th 
to 12th of the present era), and they showed toward the 
scientists the same spirit of generosity that had been 
manifested toward them by the Abbasides in the earlier 
part of their reign. In 970 A. D. Moez Eddoula drove out 
the reigning family, assumed the title of Caliph, and 
founded the city of Cairo. In 972 he built the celebrated 
mosque Al Azhar and constructed, as a sort of annex to it, 
a school, a veritable university, where ultimately all the 
sciences were taught. It throve vigorously, and students 
flocked to it in great numbers from all quarters of the 
Moslem empire. During the eleventh and twelfth centuries 
Egypt was once more, as it had been in the palmy days of 
Alexandria, the home of many excellent and vigorous insti- 
tutions of learning. Among the physicians, however, who 
received their education in medicine at Cairo during this 
long period, there was not one who attained great eminence. 

At the end of the eleventh century the Crusaders, under 
the leadership of Godfrey de Bouillon and others, made 
their first serious attack on Palestine and Syria, and from 
that time onward, for about two centuries, they and the 
different armies sent out successively from Europe carried 
on almost constant warfare, which Michaud the distin- 



.^ 



THE ARAB RENAISSANCE 225 

guished French historian (about 1800 A. D.) calls the 
product of a pious delirium. Wars of religion are the 
most savage and pitiless of all wars, says Le Clerc, and 
this was emphatically true of those waged by the Cru- 
saders. On the other hand, says the same writer, *Hhe 
tolerance exhibited at that period by the Arabs in religious 
matters is a well-attested fact, and it owes its origin to 
the circumstance that their scientific education was con- 
ducted by Christians. Of Saladin's fifteen physicians 
two-thirds were either Jews or Christians. Cultivation 
and good training were the characteristics of the Arabs at 
that period of their history, whereas fanaticism and brute 
force were the distinguishing features of the European 
soldiers. Several hundred thousand adventurers first 
ravaged Europe and then pounced upon Asia. At Antioch 
Godfrey de Bouillon committed all sorts of excesses, and 
then, when he had taken Jerusalem, he massacred 70,000 
of its inhabitants — Jews and Musulmans. Eighty years 
later, Saladin retook Jerusalem; and, with the exception 
of a comparatively small number, he allowed all of his 
captives to go free. His brother, Malek el Adel, paid the 
ransom of 2000 of the prisoners. Contrast these fruits of 
civilization with the barbarism of the European conquerors 
under Godfrey de Bouillon. Another result of the Crusades 
was this: The Franks lost a good deal of their savagery 
through contact with the Arabs. At a still later period 
Western Europe drew a large part of her supplies of knowl- 
edge from Spain — i.e., from the Musulmans." 

Syria. — In the thirteenth century Damascus, the capital 
of Syria, assumed considerable importance as a centre of 
medical activity. Bagdad and Cairo had by this time lost 
the greater part of their attractiveness for those who 
wished to perfect their knowledge of the healing art, and 
the vandalism of the so-called Soldiers of the Cross had 
put an end for many years to come to all hopes of making 
Constantinople once more the home of scientific or artistic 
effort. There was one branch of medical practice, however, 
in which the Cairo physicians excelled all others — that, 
namely, of ophthalmology. This is explained by the well- 



226 GROWTH OF MEDICINE 

known fact that at all periods of her history Egypt has 
been afflicted with ophthalmias to a much greater degree 
than any of the other countries of the Mediterranean basin. 
The great wealth accumulated in Damascus, the large num- 
ber of hospitals which were located in the city, and the 
attractiveness of the town as a place of residence undoubt- 
edly had much to do with the fact that it attained at this 
period so great popularity as a centre of medical activity. 

Spain. — During the tenth century of the present era the 
Moslem reign in Spain flourished greatly under the two 
enlightened rulers of the Ommiade Dynasty — Abdur- 
rahman Ennasser and Hakem, and medicine shared fully 
in this prosperity. During Abdurrahman's reign the 
Emperor Eomanus at Constantinople sent an embassy to 
Cordova in Spain, and among the gifts which they took 
with them for the Prince, was a copy of the treatise of 
Dioscorides in the original Greek, illustrated by marvel- 
ously beautiful paintings of the different medicinal plants. 
But there was nobody in Cordova at that time who could 
read Greek. Accordingly, Abdurrahman begged the 
Emperor to send him a man who was familiar with both 
the Greek and the Latin tongues, and it was in answer to 
this request that the monk Nicholas was sent to Cordova 
(951 A. D.). Working in conjunction with several of the 
most distinguished physicians of that city he succeeded in 
identifying nearly all of the plants mentioned by Dios- 
corides. 

Among the physicians of Arab, Persian or Jewish ex- 
traction who, during the eleventh and twelfth centuries, 
practiced their profession in Spain and attained consid- 
erable celebrity, the following deserve to receive special 
mention here: Abulcasis, Avenzoar, Averroes and Mai- 
monides. 

Abulcasis. — Abulcasis is universally credited with being 
the greatest surgeon of whom the Arabs may rightfully 
boast. He was born at Zahra near Cordova in 936 A. D., 
and his death occurred 1013 A. D. Quite early in his pro- 
fessional career (before he had reached his twenty-fifth 
year) he was appointed one of Abdurrahman's private 



THE ARAB RENAISSANCE 227 

physicians. Although he owes his reputation chiefly to 
the treatises which he wrote on surgery Abulcasis was also 
the author of several medical works. He published a col- 
lection of all his writings under the title of ''The Tesrif," 
which is divided into thirty parts or books, and which — 
according to Lucien Le Clerc — constitutes a veritable ency- 
clopaedia. During the course of the twelfth century 
Gerard of Cremona translated into Latin the part relating 
to surgery; it is not known at what time or by whom the 
remainder of the collection was translated. The author's 
name in the Latin edition is given, not as Abulcasis, but 
as Alsaharavius. 

During the lifetime of Abulcasis his writings, and espe- 
cially his work on surgery, were not very highly appre- 
ciated in Spain. This was largely due to the fact that the 
Mohammedan inhabitants of that country did not look 
upon surgery with any degree of favor. The Arabs of the 
East held Abulcasis in much greater honor. Guy de 
Chauliac, the famous French surgeon of the fourteenth 
century, in his treatise on surgery, quotes Abulcasis no 
less than two hundred times. Le Clerc, in the course of his 
remarks upon the value of the surgical treatise written by 
Abulcasis, says: ''This book will always be considered, 
in the history of medicine, to represent the first formal 
and distinct scientific treatise on surgery." At the same 
time, the prevailing testimony makes it appear that the 
book contains only a small portion of original matter, a 
large part of its substance having been borrowed from 
the work of the Greek author, Paulus Aegineta. Its chief 
merit consists in the orderly and very clear manner in 
which the facts are presented, and doubtless the popu- 
larity of the book was materially increased by the fact 
that many of the instruments required for the different 
operations were illustrated pictorially. 

Lucien Le Clerc has published (Paris, 1861) a French 
translation of Abulcasis ' Treatise on Surgery, and on page 
71 of this version the following statement will be found : — 

you may also introduce into the cannula a specially 

adapted piston in copper, or a stylet the end of which is armed 



■^- 



228 GROWTH OF MEDICINE 

with cotton. Then fill the cannula with oil or some other suitable 
fluid, introduce into one end the stylet armed with cotton, and 
push it onward until the liquid enters the ear. 

Edouard Nicaise, commenting on these words in his 
version of Guy de Chauliac's La Grande Chirurgie (page 
690), says that they constitute the first reference, thus far 
discovered in medical literature, to the use of the instru- 
ment known as a syringe. 

Avenzoar. — ^Avenzoar was born in Seville, in the south- 
ern part of Spain, during the latter part of the eleventh 
century. The exact date is not known. His father was 
a physician of some distinction, and his son also attained 
considerable eminence in the same profession. According 
to Neuburger, Avenzoar died, at an advanced age, in 1162 
A. D., and was buried in Seville. 

It is said that in actual practice Avenzoar, who was a 
man of some wealth, confined himself to consultation work. 
He considered it beneath the dignity of a physician to 
prepare drugs, to apply leeches, or to perform certain 
surgical operations — as, for example, lithotomy; but 
Le Clerc seems disposed to believe that Avenzoar did not 
adopt this view until after he had become somewhat cele- 
brated and had accumulated a fortune. Neuburger ranks 
him next to Rhazes as a clinical observer and a practitioner 
of sound common sense, and he speaks of his great medical 
work, the Teissir, as a treatise that abounds in most inter- 
esting histories of cases of disease. Among these will be 
found the account of an attack of mediastinitis which 
occurred in his own person, and which ended in suppuration 
that found a vent for its products by way of one of the 
bronchi.^ As this disease is of rare occurrence, and as 
Freind's account of the attack is presumably a translation 
of the original report in Arabic made by Avenzoar, its 
reproduction here may be interesting. I shall take the 
liberty of modernizing the text very slightly and of 
abbreviating it in one or two places. 

1 For further remarks concerning the origin of the Teissir see page 229. 



THE ARAB RENAISSANCE 229 

I felt some pain in the region of the mediastinum (the membrane 
which divides the thorax in the middle) while I was on a journey. 
As it increased a cough developed, and I observed that my pulse 
was very hard and that I had an acute fever. On the fourth night 
I took away a pint of blood, but this gave me very little relief. 
Being obliged to travel all day I was much fatigued when I retired 
at night, and I fell asleep. During my sleep the bandage on the 
arm came off, and when I awoke I found the bed deluged with 
blood and my strength greatly exhausted. The next day I began 
to cough up a sanious matter, and my mind wandered at times. 
Gradually all the symptoms subsided and I recovered my health. 
Although I partook of large quantities of barley water, I believe 
that my recovery was not due to this, but rather to the great loss 
of blood which I had experienced. 

Freind adds that ''Avenzoar not only takes notice of an 
abscess in the mediastinum, but in the pericardium like- 
wise; which I don't find had been described or even ob- 
served by any of the Greeks or Arabians : and there is no 
doubt but this membrane and the mediastinum to which 
it is contiguous, are subject, as well as the pleura and lungs, 
to an inflammation." 

It is one of the distinguishing features of Avenzoar's 
character that, in his writings, he does not hesitate to 
differ from his predecessors whenever he believes that 
their views are erroneous. 

Averroes. — Averroes was one of Avenzoar's most dis- 
tinguished pupils. Indeed, the latter 's famous work, the 
Teissir, is dedicated to Averroes. Thanks to the distin- 
guished French historian and philosopher, Ernest Renan, 
our knowledge of Averroes has been greatly expanded 
since 1852. Averroes was born at Cordova in 1126 A. D. 
His father and his grandfather had both held the office of 
Cadhi (Alcalde, in Spanish), and were therefore people 
of importance in that city. His studies were confined at 
first largely to philosophy, and when he reached mature 
age he gained a great reputation as the commentator and 
interpreter of the writings of Aristotle. Still later in life 
much of his attention was devoted to medicine, and he 
wrote a book which bears the title **Kitab al-kullidschat" 



230 GROWTH OF MEDICINE 

(General principles of Medicine). Among the physicians 
of the later Middle Ages this work was commonly spoken 
of as the **Colliget" (from kullidschat), and was almost 
as highly esteemed as the Canon of Avicenna. The idea 
of writing a treatise on the individual diseases was first 
entertained, among Arabian physicians, by Averroes; but 
on reflection he abandoned the idea, and, instead, urged 
Avenzoar, his friend and former instructor, to undertake 
the work in his place. It was in this way that the Teissir — 
the finest work on the practice of medicine produced by an 
Arab writer — came to be written. 

The topics treated in the ''Colliget" are distributed 
throughout the seven books in the following manner: — 

Book I. Anatomy. 

Book II. Health (Physiology). 

Book III, Diseases, 

Book IV. Signs or Symptoms, 

Book V. Remedial agents and Foods. 

Book VI. The Preservation of Health. 

Book VII. The Treatment of Diseases. 

Neuburger speaks of the ''Colliget" as a fine piece of 
philosophical writing, but adds that it is not at all suited 
to the needs of the practical physician. Indeed, he doubts 
whether any person who has not received a thorough train- 
ing in natural philosophy — the philosophy of Aristotle — 
would be able to follow the author intelligently. 

Maimonides. — Maimonides, who is ranked by Le Clerc 
as the greatest Jew, after Moses, of whom the history of 
that nation makes mention, was born at Cordova, Spain, 
in 1135 A. D. In early youth his teachers were his father 
and a disciple of Ebn Badja. At the age of thirteen, and 
from that time until he had reached his thirtieth year, he 
was obliged under the pressure of circumstances, to pro- 
fess, at least outwardly, the faith of Islam. Death or 
banishment was the only alternative. During the inter- 
vening period of seventeen years he devoted himself 
exclusively to his studies. In 1160 A. D. he accompanied 
his family to Fez, Morocco, and five years later he settled 



TEE ARAB RENAISSANCE 231 

at Fostath, near Cairo, Egypt. As a means of gaining Ms 
livelihood he engaged in the business of trafficking in 
precious stones, continuing his studies at the same time 
and carrying on a certain amount of medical practice. Not 
long afterward he gained the favor of the Vizir El Fadhl 
Beissany, the friend of Saladin, Sultan of Egypt and 
Syria, and was by him appointed one of the Court physi- 
cians. This enabled him to give up entirely his commercial 
business. He prospered in the practice of medicine and 
was very highly esteemed in the community in which he 
lived. His death occurred in 1204 A. D. 

Among the books which he wrote (generally in Arabic) 
on medical subjects, the following deserve to receive special 
mention : — 

I. Commentary on the Aphorisms of Hippocrates. 
II. A work known as "Aphorisms of Maimonides" (borrowed 

partly from Hippocrates and partly from Galen), 
HI. Resume of the writings of Galen. 
IV. A letter relating to the subject of personal hygiene. 
V.-IX, Treatises on asthma; on hemorrhoids; on venoms and 
poisons in general ; on drugs ; and on forbidden articles 
of diet. 
X. A translation of one of Avicenna's works. 

Neuburger speaks in very favorable terms of the medical 
writings of Maimonides, and adds that he also wrote a 
treatise which bears the title: ** Guide to Those in Per- 
plexity" — a work which aims to reconcile reason and faith. 
The book has been translated into French by Munk; and 
the treatise on poisons has also been translated into the 
same language by J. M. Rabbinowicz (Paris, 1867). 

Speaking of the remarkable manner in which philosophy 
and medicine had flourished in Spain during the tenth and 
eleventh centuries, under the reigns of Haken II. and his 
successors, Ernest Renan says : 

The love of science and of things beautiful had established, in 
that privileged corner of the world, a degree of tolerance that can 
scarcely be matched in modern times. Christians, Jews, Musul- 
mans all spoke the same language, sang the same poems, and took 



232 GROWTH OF MEDICINE 

part in the same literary and scientific studies. All the barriers 
which commonly separate men were thrown down, and all worked 
with equal zeal in behalf of our common civilization. 

"With the death of Averroes (1198 A. D.), however, Arab 
philosophy lost its last representative, and the Koran 
resumed its full authority over freedom of thought. In the 
succeeding period of decadence (thirteenth century of the 
Christian era) there were no physicians of first importance, 
at least in Spain and Persia ; and even in Egypt and Syria, 
over which reigned at this time the enlightened family of 
Saladin, the leading physicians were not of the same 
calibre as the men whose names I have just mentioned. 
Bagdad and Cordova had by this time become cities of less 
importance than Damascus, and botany and ophthalmology 
were esteemed of greater value in the scheme of medical 
education than at any previous time. It will not appear 
strange, however, that medicine should have stood still 
during this later part of the Middle Ages if we bear in mind 
the fact that warfare was then such a frequently occurring 
event that nobody had either time or inclination for scien- 
tific studies. The invasions of the Mongolians and the 
Crusaders were most disturbing factors. 

During the twelfth century of the present era there 
were — so we are assured by Le Clerc — women physicians 
among the Arabs in Spain. It is said, for example, that 
Abou Bekr, a distinguished medical practitioner of that 
period, had a sister who was well trained in medicine, and 
that it was she who acted as midwife at all the confinements 
of the wives of the Caliph Almansur. After her death her 
niece officiated in the same capacity in her place. There 
can scarcely be any reasonable doubt that, almost from 
time immemorial, women as well as men have taken active 
part in the practice of medicine. 

According to Puschmann, Spain possessed, during the 
twelfth century of the Christian era, seventy public libra- 
ries and seventeen institutions for instruction in the higher 
branches of learning. Among the residents of the city of 
Cordova there were, during the same period, no fewer than 
one hundred and fifty authors; and the smaller cities of 



THE ARAB RENAISSANCE 233 

Almeria, Murcia and Malaga could each claim propor- 
tionally an equally large number, viz., fifty- two, sixty-one 
and fifty-three. 

The Effects of the Arab Renaissance as a Whole upon 
the Evolution of Medicine. — Although the series of events 
which I have endeavored to sketch here in brief outlines 
reveals an extraordinary degree of zeal and persistence 
on the part of the Arab rulers and their subjects to endow 
the nation with the knowledge and skill of their models, the 
Greeks, the final results gained, at least so far as they relate 
to the evolution of medicine as a whole, were not very 
great. The movement lasted for five or six centuries, but 
nevertheless only a few relatively unimportant facts were 
added by the Arabs to the stock of knowledge which was 
possessed at the time of Galen's death. Alhazen's bril- 
liant researches in the eleventh century of our era in optics 
(more particularly with reference to refraction) paved the 
way for a more perfect knowledge, in modern times, of the 
physiology of vision; Geber, who lived during the eighth 
century of the Christian era, and who is spoken of by 
Le Clerc as '* occupying the same place in the history of 
chemistry that Hippocrates does in the history of medi- 
cine," laid the foundations of that important branch of 
science; Abulcasis discovered the Medina worm {dracun- 
culus Medinensis) and wrote an excellent description of 
the pathological effects which it produces when it lodges 
under the skin of a man's leg; and, finally, our pharma- 
copoeia was enriched, during these centuries, by the 
addition to it of a number of new drugs and pharmaceu- 
tical preparations. These are among the more important 
contributions which the Arabs made to the general stock 
of medical knowledge. On the other hand, they contributed, 
in an indirect manner, to the advance of the science of 
medicine. From the thirteenth century onward, for a long 
period, the Latin language was destined to serve as the 
vehicle by means of which all scientific knowledge was to 
be spread abroad in the countries which are now known as 
Italy, Spain, France, Switzerland, Germany, Belgium and 
Holland, and therefore an immense amount of translating 



334 GROWTH OF MEDICINE 

had to be done before the works of Hippocrates, Galen and 
other Greek medical authors could be brought within reach 
of the physicians of these different countries. At that late 
date it was by no means always feasible to get possession 
of an original copy of one of these classical treatises, and 
consequently in such cases it became necessary to employ 
an Arabic version in the place of the Greek original. 
It was in this indirect manner, therefore, that the 
Mohammedan Renaissance contributed most effectively 
in advancing the development of medical science in general. 
One cannot dismiss the subject of Arabic medicine with- 
out calling attention once more to the spectacle which this 
remarkable Renaissance offers — that of an entire nation 
deliberately working to educate itself up to the level of 
such intellectual and artistic giants as the ancient Greeks ; 
a work which continued with unabated zeal throughout 
several centuries in spite of obstacles and discouragements, 
and which never ceased for a moment. It is a spectacle 
without parallel in the world's history. 



CHAPTER XX 

HOSPITALS AND MONASTERIES IN THE MIDDLE 

AGES 

Long before the Christian era it was the practice among 
the Greeks to make suitable provision for those who, by 
reason of poverty or illness, were unable to provide for 
their own wants or to secure the services of a physician. 
Their slaves, for example, were sent, when overtaken with 
illness, or when they had become too feeble to work, to 
what was termed Xenodochia — institutions where they 
received kindly care and such medical treatment as was 
necessary. (Mommsen.) In strong contrast with this 
humane practice stands the action of those wealthy Roman 
property owners who, adopting the course recommended 
by Cato, the famous censor (96-46 B. C), ''sold their slaves 
when they became old and feeble or ill, as they would old 
iron, or oxen that can no longer be utilized for work." 
This cruel practice not only continued throughout a period 
of nearly three centuries, but apparently became more 
and more common, for we are told that the Emperor 
Claudius (268-270 A. D.) was obliged, in order to mitigate 
the evil, to issue a decree that, when a slave was driven 
out of the house by his owner, he should be declared free. 

Hospitals and Other Kindred Institutions. — Toward the 
end of the fourth century of the present era the first 
hospital was established in Rome by the widow Fabiola, 
a member of the distinguished Fabian family, and her 
example induced other wealthy Roman ladies to found 
similar institutions. But already several years before this 
time the influence of Christianity had made itself felt so 
strongly in the eastern branch of the Roman Empire that 



236 GROWTH OF MEDICINE 

the Emperor Julian, who had previously been among its 
most bitter opponents, was forced to say, in one of his 
letters : — 

Now we can see what it is that makes these Christians such 
powerful enemies of our gods; it is the brotherly love which they 
manifest toward strangers and toward the sick and the poor, the 
thoughtful manner in which they care for the dead, and the purity 
of their own lives. 

Moved by these considerations, he decided forthwith to 
erect hospitals in all the cities of the empire. We do not 
know whether he acted upon this resolution or not, but it 
is a matter of record that St. Basil, Bishop of Caesarea 
(370-379 A. D.), founded in that city, which is about thirty 
miles distant from Jerusalem, a settlement composed of 
numerous dwellings that were devoted to the use of the 
poor and the sick. This institution was managed in an 
admirable manner, a special corps of physicians and nurses 
being assigned to the duty of caring for its inmates. At 
Edessa, the capital of Northern Mesopotamia, another 
hospital was founded in 375 A. D. The date of the estab- 
lishment of the celebrated hospital at Djondisabour in 
Persia, of which mention is made elsewhere (see page 204 
et seq.), is not known. About the middle of the sixth cen- 
tury of the present era, Childebert I., King of the Franks 
and son of Clovis, founded at Lyons, France, the Hotel- 
Dieu, a hospital which has afforded shelter and comfort 
to thousands of human beings during the past fourteen 
hundred years, and which is in active operation at the 
present time ; a hospital, too, which has served as a training 
school for a long line of distinguished physicians, surgeons 
and gynaecologists. It is an interesting fact that Childe- 
bert intrusted the management of this great institution to 
laymen (instead of the ecclesiastical powers). Finally, 
toward the end of the sixth century, Bishop Masona 
founded in Merida, Spain, a hospital in which Jews, slaves 
and freemen were received and treated on the same foot- 
ing ; and he laid down the rule that one-half of the moneys 
and other gifts received by the church was to be devoted to 



HOSPITALS AND MONASTERIES 237 

the maintenance of this institution. The list of hospitals 
and other charitable organizations which were established 
in these early centuries is very long, and it reveals the fact 
that in every known land there existed, throughout these 
years, a strong wish to give aid and comfort to the poor, 
the sick and the helpless. The Musulmans appear to have 
been as zealous as the Christians in promoting works of 
this kind; for the records show that in Bagdad, Cairo, 
Damascus, Cordova and many of the other cities which 
were under their control, they provided ample hospital 
accommodations. Indeed, one of the largest and most 
perfectly equipped institutions of this character of which 
the history of the Middle Ages furnishes any record, was 
that planned and constructed at Cairo, Egypt, in 1283 
A. D., by the Sultan El Mansur Gilavun. While it was 
building, the workmen employed were not permitted to 
engage in any undertaking for private citizens, and the 
Sultan himself never failed to visit the spot every day 
during the progress of the work. The site chosen was that 
of one of the royal palaces, and in tearing down this 
structure, in order to make room for the new building, the 
workmen brought to light a large chest filled with gold and 
precious stones, the value of which was sufficient to pay 
the entire expense of erecting the hospital. Upon the 
completion of the building and the equipment of its spacious 
wards in the most perfect manner possible, the Sultan 
expressed himself in the following terms: — 

I have founded this institution for people of my own class and 
for those who occupy an humbler station in life — for the king and 
for the servant, for the common soldier and for the Emir, for the 
rich man and for the poor, for the freeman and for the slave, for 
men and also for women. I have made ample provision for all 
the remedial agents that may be required, for physicians, and for 
everything else that may prove useful in any form of illness 

One of the characteristic features in the management of 
this hospital, says Le Clerc, was the custom of giving to 
each of the poorer inmates, when he left the institution, 
five pieces of gold, in order that he might be spared the 



238 GROWTH OF MEDICINE 

necessity of undertaking immediately work of an exhausting 
character. 

Monasteries in Their Relation to Medicine. — While at 
first these institutions were designed chiefly as places of 
refuge from the turmoil of the world and from the violence 
of frequent warfare, it became evident in the course of 
time that the evils incident to such a secluded and self- 
centered life hindered rather than promoted the develop- 
ment of those particular virtues which Jesus Christ urged 
his followers to cultivate. This experience led to the 
adoption of a different kind of cloister life ; and so it came 
about, as stated by Neuburger, that in 529 A. D. Benedictus 
of Nursia founded, at an isolated spot high up on the slope 
of Monte Cassino, in Campania, Italy, the now famous 
parent monastery of the Benedictine Order. According 
to the original regulations of this order, the monks were 
obliged to perform every day a certain amount of manual 
labor as well as devotional exercises. Nine years later 
Cassiodorus, who had for a long period been a sort of 
Secretary of State under Theodoric the Great and his 
successors, became a monk, and, from that time to the day 
of his death, * ' devoted all his energies to the service of God 
and the advancement of science. ' ' He secured a house not 
far from the Benedictine monastery on Monte Cassino, 
gathered together there a considerable library, and made 
it a rule of the place that the copying of original codices 
(the majority of them theological) constituted the most 
useful and honorable form of manual labor. A few years 
later, this smaller establishment was made a part of the 
monastery at Monte Cassino, and the rule just mentioned 
was thereafter adopted by the enlarged institution. But 
the care of the sick, the feeble, and children was the par- 
ticular work which Benedictus, the founder of this institu- 
tion, had most at heart. Cassiodorus went even farther 
and urged upon the brethren the desirability of studying 
the healing art and of utilizing, for this purpose, the works 
of ancient medical authors. 

Learn all you can, he said, about the characteristics of different 
plants and about the methods of preparing medicinal mixtures, 



HOSPITALS AND MONASTERIES 239 

but set all your hopes upon the Lord who is the preserver of our 
lives. In your search for knowledge about drugs consult the 
herbarium of Dioscorides, who has described and pictured the 
different herbs with great accuracy. Afterward read Latin trans- 
lations of the works written by Hippocrates and by Galen, par- 
ticularly the latter 's treatise on therapeutics, the one which he 
addresses to the philosopher Glaucon; and, in addition, study the 
work of Caelius Aurelianus on the practice of medicine, that of 
Hippocrates on medicinal plants and methods of treatment, and 
some of the other writings on medicine which you will find in my 
library and which I have left behind me for the benefit of my 
brethren in this institution. 

The advice given by Cassiodorus was heeded, not only 
by those to whom it was addressed, but also by many suc- 
ceeding generations of monks. Even at the present time, 
says Neuburger, the books which Cassiodorus recommended 
are still to be found, either in the form of original manu- 
script copies or in that of translations, in the library of 
the parent institution. Furthermore, when it is remem- 
bered how large a number of affiliated Benedictine monas- 
teries were established in different parts of Europe, it will 
readily be appreciated that the good accomplished by the 
advice which Cassiodorus gave must have been very great. 

Among the later abbots of Monte Cassino there were 
three who attained considerable distinction as physicians. 
They were Bertharius, who wrote two treatises on medical 
topics; Alphanus II., Archbishop of Salerno, who was 
celebrated both as a physician and as a poet ; and Desiderius 
(1027-1087 A. D.), who was skilled, not only in medicine, 
but also in jurisprudence, and who was elected Pope under 
the title of Victor III. The monastery attained the height 
of its celebrity at the time when Constantinus the African 
became one of its regular members. Although Constan- 
tinus was a native Arab (born at Carthage about 1018 
A. D.), he became converted to Christianity quite early in 
life. It is said that he was a great traveler as well as a 
great scholar, and that he devoted several years to visiting 
foreign lands — Babylonia, India, Egypt and Ethiopia. It 
was in this way that he became so well versed in the Ian- 



240 GROWTH OF MEDICINE 

guages of the East. Upon visiting Spain as a fugitive 
from his native city, he took with him several of the works 
of Hippocrates and Galen, and in course of time translated 
them into Latin. Finally, he accepted the position of 
secretary to Robert Gruiscard, the first Norman Duke of 
Calabria and Apulia, who appears to have selected Salerno 
as his place of residence. At the same time he became one 
of the teachers at the medical school of that city, and served 
in this capacity for a certain length of time ; but, at the end 
of a few years, he was formally accepted by the Abbot 
Desiderius as a member of the Monte Cassino community, 
and it was here that he did the larger part of his literary 
work. His death occurred in 1087 A. D., the same year in 
which the Abbot Desiderius — or, rather, Pope Victor III. — 
died. 

Constantinus was a prodigious worker, but it is doubtful 
whether he did anything of an original character. Not a 
few of the treatises which were, at that time, credited to 
him as original productions, are now known — thanks 
largely to the researches of the great French historian and 
linguist, Daremberg — to be simply translations from the 
Arabic. 

It is believed by some authorities that at Monte Cassino 
medicine was taught to laymen as well as to those who were 
preparing to become members of the Benedictine Order 
of monks. It is not likely, however, that this was done 
to any great extent, as much better facilities for acquiring 
knowledge of medicine were available at Salerno in the 
near neighborhood. 

In some parts of Gaul, in the early Middle Ages, physi- 
cians received very little consideration; indeed, to us 
moderns it seems strange that any one should have pos- 
sessed sufiicient courage to accept the responsibility of 
prescribing for a member of one of the royal families. It 
is related by Neuburger, on the authority of Gregory of 
Tours ' History of the Franks, that when Austrichildis, the 
wife of King Guntram (sixth century A. D.), was ill with 
the plague and perceived that her death was near at hand, 
she sent for her husband and extracted from him a 



HOSPITALS AND MONASTERIES 241 

promise that he would behead the two physicians, Nicolaus 
and Donatus, who had treated her and whose prescriptions 
had failed to effect a cure. Her wish was carried out, in 
order — as the statement reads — *Hhat her Majesty might 
not enter the Realm of the Dead entirely alone." Many 
centuries later, however, when civilization had certainly 
advanced far beyond the stage which it had reached in Gaul 
in the sixth century of the present era, there were instances 
in which able and conscientious physicians were subjected 
to equally cruel treatment for their failure to effect a cure. 

It was at about this same period, as is amply verified 
by the statements made by Bishop Gregory of Tours, that 
faith in the power of saintly relics to heal diseases became 
almost universal. So great was the effect produced upon 
the minds of the people by the public display of these 
objects — bones of saints, portions of their grave-stones, 
etc. — that a large number of marvelous cures were reported 
as the result of such displays; and doubtless — so great is 
the power of suggestion over the human mind — many of 
these reports were true. A century later (673-735 A. D.), 
the Venerable Bede, author of the famous work entitled 
*' Ecclesiastical History of the English Nation," gave, in 
the course of his narrative, an account of a case of aphasia 
in which * ' a remarkable cure was effected ' ' ; and, although 
he mentions a course of ** systematic exercises in speaking" 
as the means used to effect that cure, he attributes it to 
supernatural causes and not to the practical treatment 
adopted. He also describes some of the epidemics of his 
time, and gives most interesting though brief accounts of 
the methods of treatment employed by the priests and the 
monks. 

During the ninth and tenth centuries, as we learn from 
the very full descriptions given by Neuburger in his History 
of Medicine, much zeal was manifested by the monks at 
St. Gall in Switzerland, at Reichenau in Saxony, and at 
Fulda, in Hesse Nassau, in the study of the different 
branches of knowledge, medicine included. The following 
are the names of those monks who attained the greatest 
distinction in this work: Hrabanus Maurus, Abbot of the 



242 GROWTH OF MEDICINE 

Fulda Monastery, afterward Archbishop of Mayence, and 
the author of an encyclopaedia in which the science of 
medicine receives quite full consideration; and Walahfrid 
Strabo, a pupil of Maurus, Abbot of Reichenau, and the 
author of a treatise in verse on medicinal plants. 



CHAPTER XXI 

MEDICAL INSTRUCTION AT SALERNO, ITALY, IN 
THE MIDDLE AGES 

The date of origin of the Medical School at Salerno is not 
known, but such evidence as we possess shows without a 
doubt that already in the earliest part of the Middle Ages 
some sort of facilities for studying medicine were provided 
in that little town — the Civitas Hippocratica, as it was 
called at a later period. It seems to be the general impres- 
sion, says Daremberg, that during those early centuries 
only ignorance and superstition prevailed in Italy and 
Gaul ; in other words, that all desire for scientific research 
had vanished, and that there no longer existed such a thing 
as the regular practice of medicine. This impression, he 
adds, is erroneous. History shows that schools modeled 
after those established by the Merovingian and Carlo- 
vingian kings (448-639 A. D.), existed up to as recent a 
date as the middle of the seventh century, and that subse- 
quently the bishops organized the teaching in such a manner 
that it should be entirely under their control. As time 
went on, however, the schools assumed a more public 
character, although the actual teaching was still carried 
on in the cloisters and church edifices. It is well known, 
furthermore, that the chief of the Ostrogoths, Visigoths 
and Lombards — the so-called Barbarians, who at that time 
occupied these parts of Europe as conquerors — showed 
themselves on many an occasion to be the enlightened 
protectors of public instruction and the enthusiastic 
admirers of classical literature and science. 

At Milan there is preserved a manuscript which furnishes satis- 
factory proof that the writings of Hippocrates and Galen were 



244 GROWTH OF MEDICINE 

made the subject of public teaching at Ravenna toward the end 
of the eighth century of the present era And the tran- 
scribing of medical manuscripts was known to be carried on at the 
Monastery of St. Gall, in Switzerland, during the eighth cen- 
tury It is plain, therefore, that throughout those extensive 

regions which previously had formed a part of the Roman Empire, 
but which during the Middle Ages were under the dominion of 
Barbarian kings, there was never an entire lack of physicians, or 
of medical knowledge, or of facilities for teaching medicine. 
(Daremberg.) 

In the light of these statements it is easy to believe that 
the original development of the Medical School at Salerno 
was a perfectly natural event like that of the founding of 
any of the medical schools of a more recent date. The 
remarkably healthy and singularly attractive character of 
the spot where the town of Salerno is located ; the proximity 
of mineral springs ; the comparatively short distance which 
separated it from such important centres of population as 
Naples and the cities of the Island of Sicily, and from the 
famous Benedictine Monasteries at La Cava, Beneventum 
and Monte Cassino; and the circumstance that a Ducal 
Court was established there — all these are facts which 
amply explain both why a medical school was founded here 
rather than at some other spot, and why physicians of 
exceptional ability were easily induced to make the place 
their home. At no time in the history of the school, it is 
important to state, do the church authorities appear to have 
been in control of its affairs. At most, one or two of the 
monks seem to have taken part in the teaching for limited 
periods of time ; but in its main characteristics the school 
may truthfully be described as an institution created and 
managed by physicians for the advancement of medical 
science and the best interests of the profession as a whole.* 
The organization of hospitals and their utilization for 
purposes of clinical instruction must have been the most 
important events which followed next in order. It is only 

* According to tradition the medical school at Salerno was founded by four 
physicians — Adela, an Arab; Helinus, a Jew; Pontus, a Greek; and Salernus, 
a Latin. 



MEDICAL INSTRUCTION AT SALERNO 245 

upon this assumption that we can satisfactorily explain 
why, for many years in succession, physicians traveled all 
the way from France, Germany and England to Salerno. 
They were eager to gain additional knowledge of medicine, 
and clinical instruction afforded the only sure way of 
obtaining it ; but instruction of this kind was nowhere else 
to be obtained at that remote period, and consequently men 
of this earnest and ambitious stamp were compelled to 
make the long journey and to incur the expense and the 
risk incident to such a trip. As a further evidence of the 
value which the physicians of the later Middle Ages set 
upon the writings of the teachers at Salerno, the fact 
deserves to be mentioned that, toward the end of the twelfth 
century and all through the thirteenth and fourteenth 
centuries, these works were frequently quoted. 

But the ability and learning of the Salerno physicians 
were highly appreciated by the public at large as well as 
by their confreres in other lands ; for many people of wealth 
and of high social standing visited Salerno for the purpose 
of consulting them. Among the number were Adalberon, 
Bishop of Verdun, France, who journeyed thither in 984 
A. D., but failed to obtain the relief which he required; 
Desiderius, the Abbot of Monte Cassino; Bohemund, the 
son of Duke Robert Guiscard ; and William the Conqueror, 
afterward King of England. The two last named remained 
for some time in Salerno, in order to secure needed treat- 
ment for the wounds which they had received in battle. 

Toward the end of the tenth, or at the beginning of the 
eleventh, century the teaching of medicine at Salerno began 
to assume the character of regularly organized work. The 
names of the men and women who conducted it — for there 
were women as well as men in the corps of teachers — are 
mentioned in various contemporaneous documents which 
have come down to our time. They are as follows: 
Petroncellus, Gariopuntus, Alphanus, Bartholomaeus, 
Cophon, Trotula, John and Matthew Platearius, Abella, 
Mercuriade, Costanza Calenda, Rebecca Guarna, Aflflacius, 
Maurus, Musandinus and many others. According to 
Puschmann, the list of physicians who, during the exist- 



246 GROWTH OF MEDICINE 

ence of the Medical School at Salerno, — a period of nearly- 
one thousand years, — acted as teachers in the institution, 
comprised no less than 340 names. The presence of several 
women among the instructors of this school, and the great 
esteem in which they were held by the men of that time, 
both for their ability as practitioners and for the excellence 
of the treatises which they wrote, furnish strong confirma- 
tion of the statement which Plato makes in his work 
entitled ' ' The Eepublic, ' ' and which I have already quoted 
in one of the earlier chapters, viz. : * ' For women have as 
pronounced an aptitude as men for the profession of 
medicine." And, if further evidence of the correctness of 
Plato's opinion were needed, the success attained by 
women physicians during the past thirty or forty years in 
the United States of America might be cited. 

To the general statement made above I may with 
advantage add a few details regarding both the individual 
physicians at Salerno and the books which they wrote. 
During recent years, thanks to the researches of Henschel, 
de Eenzi and Piero Giacosa, our knowledge of these matters 
has been greatly enlarged. In 1837 Henschel found, in the 
library at Breslau, Germany, a manuscript collection of 
Salerno medical treatises ('* Compendium Salernitanum") 
dating back as far as the latter part of the twelfth century 
of the present era. De Eenzi, working in association with 
Daremberg and Baudry de Balzac, succeeded in collecting 
from the different libraries of Italy quite a large number 
of additional Salerno treatises, all of which have since been 
published under the title ^^Collectio Salernitana, ossia 
documenti inediti e trattati di medicina appartenenti alia 
scuola medica Salernitana'^ (5 vols., Naples, 1852-1859). 
Finally, Piero Giacosa has added to this stock of Salerno 
writings by the publication (Turin, 1901) of a work which 
bears the title '^Magistri Salernitani nondum editi etc.'' 
Beside the treatises to be found in these three collections 
there is one other which, according to Neuburger, contrib- 
uted more than all the others combined to the fame of the 
Medical School of Salerno. The title of this extraordinary 
work is: *' Regimen sanitatis Salernitanum." 



MEDICAL INSTRUCTION AT SALERNO 247 

The Salernian writings, it appears, may readily be 
divided into two groups — those of the earlier and those of 
the later epoch of this famous school. The treatises which 
belong to the older epoch are written in the degraded Latin 
of the Middle Ages, and seem to have been composed 
entirely for didactic purposes. In the main they are 
compilations of still earlier Graeco-Latin works, but here 
and there, especially in the parts which relate to thera- 
peutics, evidences of a certain m'easure of originality are 
discoverable. The pathology adopted shows a hodge-podge 
of the humoral doctrine and that of the Methodists. 

The chief representative of this early epoch is Gario- 
pontus (first half of the eleventh century), whose treatise 
on special pathology and therapeutics — entitled ^^Passion- 
arius ' ' — was very popular for a long period of years. Next 
in order comes Petroncellus, whose ^^Practica" calls for 
no special comment. Of the works of Alphanus, John 
Platearius (the elder) and Cophon (the elder), we possess 
only fragments. Trotula, who lived about 1059 A. D. and 
was believed to be the wife of John Platearius I., attained 
greater celebrity than any of those just mentioned. She 
was related to Eoger I., Count of Sicily, and was therefore 
probably of Norman extraction, and she was considered by 
her contemporaries to be very learned {^^ sapiens mat- 
rona^^).^ Her writings, which are quite numerous, are 
frequently quoted by later authors, this being especially true 
of her work on diseases of women. The four other women 
who took an active and creditable part in the work of the 
Salerno Medical School also wrote treatises on various sub- 
jects: Abella, on '* Black Bile" (written in verse) ; Mercu- 
riade, on ** Pestilential Fever," and also on ''The Treatment 
of Wounds"; and Rebecca Guarna, on ''Fevers." In the 
case of Costanza Calenda, the daughter of the Dean of the 
medical school and a woman remarkable for her wisdom 
as well as for her great beauty, no record of the treatises 
which she wrote appears to have been preserved. 

The later epoch of the literature created by the Medical 
School of Salerno begins about the year 1100 of the present 

1 Perhaps the French title ' ' sage-f emrae ' ' originated from this. 



248 GROWTH OF MEDICINE 

era, after the Latin translations and compilations made by 
Constantinus the African had taught the physicians who 
were then at the head of affairs something about the 
medicine of the Arabs, and had, at the same time, through 
the latter medium, brought to their attention afresh the 
teachings and practice of the ancient Greeks.^ Among the 
works of the latter character — works which in their Latin 
dress proved most valuable to the Salerno physicians — are 
the following: "The Aphorisms of Hippocrates"; 
"Galen's Ars Parva^^ (Mikrotechne) ; and the same 
author's "Commentaries on the Hippocratic Writings." 

John Afflacius, a monk who lived during the latter half 
of the eleventh century of the present era^ was one of the 
pupils of Constantinus. His treatise "On Fevers," 
according to Neuburger, contains ample evidence of the 
author's ability as a clinical observer. 

Something still remains to be said concerning Bartholo- 
maeus, Cophon the Younger, John Platearius the Younger 
and Archimathaeus. They have already been mentioned 
in the list of authors whose writings contributed materially 
to the celebrity of the Medical School of Salerno, and it is 
now only necessary to furnish a few particulars with 
regard to their lives and the nature of the work which they 
accomplished. 

Bartholomaeus wrote a treatise (entitled "Prac^ica") 
on the practice of medicine as taught by Hippocrates, 
Galen, Constantinus and the Greek physicians. Its endur- 
ing popularity is evidenced by the facts that it was trans- 
lated at an early period into several languages and that 
portions of its text are often quoted by later authors. The 
book contains ample evidence that its author was a very 

2 There can be no question, says Neuburger (in agreement with Daremberg), 
about the truth of the statement that Constantinus allowed the authorship of 
several of the treatises issued at Salerno under his name to be attributed to 
himself — as, for example, the "Liber Pantegni" (Pantechni) , which is in 
reality the "Liber Begalis" of Haly Abbas; the " Pieticum," which is funda- 
mentally the work of fbn-al-Dschezzar; the "De Oculis," which is based upon 
Honein ben Ischak's treatise on opthalmology; and still other works which 
it is not necessary to specify. 



MEDICAL INSTRUCTION AT SALERNO 249 

close observer and a physician who strove to make accurate 
diagnoses. 

Cophon the Younger (about 1100 A. D.) was the author 
of two. works : a treatise on anatomy which bore the title 
^'Anatomia Porci," and one on the practice of medicine 
{^^ Practical ^). The ancients, it is stated, selected a pig for 
purposes of anatomical study ''because its internal organs 
present a very close resemblance to those of the human 
being." Both books are written in a clear and simple 
style. 

John Platearius the Younger was the author of a work 
on internal medicine {^^Practica Brevis^^) and also of one 
on the subject of urine {^^Regulae Urinarum^^). 

Archimathaeus wrote and published three treatises : one 
on ''Urines," another on practical medicine {^' Practical ^), 
and the third on ' ' The Demeanor which a Physician should 
Observe when he Visits a Sick Person" ("De Aventu 
MedicV'). The latter treatise, says Neuburger, is "a 
mixture of piety, artlessness, and slyness ; but it furnishes 
a capital picture of the carefully regulated behavior of the 
mediaeval physician at the patient 's bedside, of the manner 
in which he conducted his examination of the case, and 
of his intercourse with the household as well as with the 
sick person." 

In addition to the treatises referred to above, — treatises 
which are known to have been written by the authors to 
whom I have credited them, — the Collectio Salernitana 
contains several of which the authorship is not known. 
One of these, which bears the title "De Aegritudinum 
Curatione," is reputed to furnish a better account of the 
special pathology and therapeutics taught at the Medical 
School of Salerno during the height of its celebrity than 
is to be found in any of the other treatises. In one part 
of the book — that, namely, in which local affections are 
discussed — the anonymous author gives in succession the 
opinions held by the seven leading teachers of the school 
(Platearius II., Cophon II., Petronius, Afflacius, Bartholo- 
maeus, Ferrarius and Trotula) with regard to each one of 



250 GROWTH OF MEDICINE 

a certain number of local diseases; thus enabling the 
reader to obtain a very fair idea of what was the condition 
of medical science at Salerno during the twelfth century 
of the present era. 

The famous didactic poem known as the ''School of 
Salerno" {Schola Salernitana) and also as the ''Code of 
Health of the School of Salerno" {Regimen Sanitatis 
Salernitanum), was composed originally about 1100 A. D. 
It was clearly intended in the first instance for the guidance 
of laymen in matters relating to diet, the conservation of 
health and the prevention of disease; but from time to 
time, as the years rolled on, there were added to it several 
sections which changed materially the character of the 
poem. From a mere code of health it became eventually 
a fairly complete cyclopaedia of medicine in versified 
form; the number of the verses having increased fully 
tenfold during this long period. The poem, in its latest 
state, is arranged in ten principal sections, as follows: 
Hygiene (8 chapters) ; materia medica (4 chapters) ; 
anatomy (4 chapters) ; physiology (9 chapters) ; etiology 
(3 chapters) ; significance of different signs (24 chapters) ; 
pathology (8 chapters) ; therapeutics (22 chapters) ; 
nosology (20 chapters) ; and the practice of medicine as 
actually experienced (5 chapters). 

The work has been translated into nearly every modern 
language, and, according to an estimate which was made 
in 1857, there are in existence no fewer than 240 different 
editions. The most recent of these is the French trans- 
lation made by Meaux Saint-Marc and published by him 
(2d edition) in Paris in 1880. There are two English 
versions — that by A. Croke (Oxford, 1830), and the more 
recent one by John Ordronaux (Philadelphia, 1871). 

Some authorities make the statement that the poem was 
written originally for the guidance of Robert, the son of 
William the Conqueror; but Neuburger says that the 
dedication of the work to this prince is lacking in many 
of the original manuscript copies and that in some instances 
the word "Francorum" is to be found in the place of 



MEDICAL INSTRUCTION AT SALERNO 251 

''Anglorum"; for which reason he believes that the 
introduction of a dedication was made long after the poem 
had been written. It will probably appear strange to most 
readers that the author of the ^^ Regimen Sanitatis^^ (or 
^^Flos Medicinae/' as it was sometimes called) should have 
written his text in the form of verse rather than in that 
of prose. He himself states briefly, at the end of the poem,' 
some of the reasons why he preferred to adopt this course. 
Ehythm, he maintains, makes it easy to say a great deal in 
a few words ; besides which, it facilitates by its novelty the 
memorizing of new facts, and also enables one quickly to 
recall to mind those which have been learned at some 
previous time. His judgment seems to have been entirely 
correct, for the book proved to be immensely popular, and 
retained its popularity throughout an extraordinarily long 
period of time. Furthermore, as already stated, it accom- 
plished a great deal toward enhancing the reputation of 
the Salerno School of Medicine. When we consider how 
difficult it must have been in those days for students of 
medicine to memorize facts which were stored in books that 
were very costly and oftentimes not obtainable at any 
price, we cease to wonder at the great popularity of this 
miniature cyclopaedia in leonine verse.* Here were to be 
found, at one-fourth or one-tenth the price of any similar 
book written in prose, all the essentials (anatomy, physi- 
ology, pathology, etc.) required by the candidate for 
medical honors; and if, perchance, he possessed a good 
memory, he might, without a very great mental effort, 
transfer the entire poem to his own private storehouse 
of facts. 

A few extracts from this remarkable piece of medical 
literature are given below, in the belief that many of our 
readers will find them of interest. 

3 Under the heading ' ' Epilogus ' ' on pages 268 and 269 of Meaux Saint- 
Marc 's version. 

* Examples of leonine versification : ' ' Contra vim mortis, nulla est herba in 
Jiortis" ; (p. 155 of Saint-Marc's version) and (from Shelley's Cloud) "1 am 
the daughter of the earth and water." 



252 



GROWTH OF MEDICINE 



OEIGINAL TEXT 
Si vis incolumen, si vis te vivere 

sanum, 
Curas toUe graves, irasei crede 

profanum, 
Parce mero, coenato parum ; non 

sit tibi vanum 
Surgere post epulas; sommini 

fuge meridianum ; 
Ne mictum retine, ne comprime 

fortiter anum. 
Haec bene si serves, tu longo 

tempore vives. 



Conditipnes Necessariae Medico. 
Clemens accedat medicus cum 

vesta polita ; 
Luceat in digitis splendida 

gemma suis. 
Si fieri valeat, quadrupes sibi 

sit pretiosus; 
Ejus et omatus splendidus at- 

que decens. 
Ornatu nitido conabere carior 

esse, 
Splendidus ornatus plurima 

dona dabit 
Viliter induetus munus sibi vile 

parabit. 
Nam pauper medicus vilia dona 

capit. 



DE. JOHN OEDEONAUX'S 

TEANSLATION 

If thou to health, and vigor 

wouldst attain. 
Shun weighty cares — all anger 

deem profane. 
From heavy suppers and much 

wine abstain. 
Nor trivial count it, after pom- 
pous fare. 
To rise from table and to take 

the air. 
Shun idle, noonday slumber, nor 

delay 
The urgent calls of Nature to 

obey. 

Demeanor Necessary For the 

Physician. 
Let doctors call in clothing fine 

arrayed, 
With sparkling jewels on their 

hands displayed; 
And, if their means allow, let 

there be had, 
To ride, a showy, rich-attired 

pad. 
For when well dressed and look- 
ing over-nice, 
You may presume to charge a 

higher price. 
Since patients always pay those 

doctors best. 
Who make their calls in finest 

clothing dressed, 
While such as go about in simple 

frieze. 
Must put up with the meanest 

grade of fees ; 
For thus it is, poor doctors 

everywhere 
Get but the smallest pittance 

for their share. 



MEDICAL INSTRUCTION AT SALERNO 253 

At Salerno the anatomical demonstration made, appar- 
ently only once a year, for the benefit of the students, 
consisted in exposing to view the abdominal viscera of the 
pig and commenting upon the features which distinguish 
them from the same organs in the human body. In the 
^^ Regimen Sanitatis" only eight lines of text are devoted 
to anatomy. 

In section IV., which relates to physiology, the text is 
more instructive and entertaining, but still — as compared 
with the splendid work accomplished by Galen — extremely 
incomplete and superficial. 

In the early part of the twelfth century, Nicolaus 
Praepositus^ composed, at the request of his colleagues in 
the school of Salerno, an **Antidotarium" — that is, a 
collection of formulae for combining together, in a single 
pharmaceutical preparation, various drugs, both those 
commonly employed in that part of Europe and others 
which were then known only to the Arabian physicians. 
This book of formulae, containing as it did descriptions 
of the effects which might be expected from the different 
preparations, and furnishing instructions with regard to 
the proper mode of employing them, served its purpose 
admirably, not only in Salerno but throughout Europe, at 
least during the Middle Ages. All the pharmacopoeias of 
a later date were based upon his ''Antidotarium," and 
indirectly upon the still earlier celebrated treatises written 
by Matthew Platearius and bearing the titles '^Glossae^^ 
and '^ Circa instans^^ (also that of '^De simplici medicina^^). 
The most remarkable item, however, which is to be found 
in the Antidotarium is that in which mention is made of 
the use of soporific sponges {^'spongia soporifera'^), for 
anaesthetizing purposes by means of inhalations, in certain 
surgical procedures. (Neuburger.) They were made by 
impregnating the sponges thoroughly with the juices of 
narcotic plants (opium, hyoscyamus, mandragora, lactuca, 
cicuta, etc.), drying them, and putting them aside until they 
were actually needed. Then the sponge was saturated for 

5 The term ' ' praepositus ' ' means the president or the dean of the school 
with which the person named is connected. 



254 GROWTH OF MEDICINE 

about an hour with hot water or steamed, after which it 
was applied over the patient's nostrils and held there until 
the inhalation of the fumes had induced sleep. 

Another Salernian treatise worth mentioning is that 
written by Peter Musandinus, under the title *'0n Foods 
and Beverages suitable for Persons affected with a Fever. ' ' 
This writer, who was one of the teachers at the school of 
Salerno about the middle of the twelfth century, says that 
great attention was paid in his time to the preparation of 
foods in such a manner as to tempt the appetite of people 
who were ill. He speaks of a meat extract which is pre- 
pared from the flesh of the chicken, and also recommends 
that a soup made by boiling a fowl in rose water be given 
to patients who are affected with diarrhoea. He even goes 
so far as to lay stress upon the importance of serving food 
to a sick person in dishes which are pleasing to the eye. 
Apropos of the subject of foods that are easily digestible 
and therefore suitable for invalids I may mention how 
Meaux Saint-Marc translates or interprets the line in the 
''Regimen Sanitatis Salernitanum" which reads fluvialis 
anas, quanta dulcedine manas! His version may be ren- 
dered into English thus : 

* ' Oh wood-duck, how gently doth thy soft flesh glide over 
the internal surface of the stomach!" 

Toward the end of the twelfth century (1180 A. D.) there 
was published at Salerno a work on surgery — the oldest 
treatise on this subject that is known to have been written 
in Italy during the Middle Ages. It is now called ' ' Roger 's 
Practice of Surgery," but originally it was spoken of (in 
accordance with a custom quite common in those days) as 
^^Post mundi fahricam," which are the first three words 
of the text. This book is of a very practical character and 
is written in a simple, straightforward style. While it 
contains the usual amount of traditional knowledge about 
surgical matters, it gives at the same time the results of 
the personal experience of Roger, of his teachers, and of 
his associates. As published in the ^^Collectio Salernitana^* 
the work represents, not the treatise as it was originally 
written, but a revision made by Rolando of Parma. It is 



MEDICAL INSTRUCTION AT SALERNO 255 

divided into four parts or books, the topics treated in which 
comprise most of those usually discussed in works on 
surgery. Under the heading ** Wounds of the Intestine," 
in Book III., there occurs this most remarkable piece of 
advice, viz., *'to insert into the intestinal canal a small 
tubular piece of elder and then to stitch the raw edges of 
the bowel together over it." 

Another treatise on surgery, entitled ^^Chirurgia 
Jamati/' was published at Salerno before the end of the 
twelfth century. Its authorship is attributed to Jamerius, 
and in many respects it resembles closely the treatise of 
Roger. 

The ^'Regimen Sanitatis^^ was not, it appears, the only 
treatise on medicine which was published at that period 
in the form of a poem. Gilles de Corbeil (Petrus Aegidius 
Corboliensis), who had received his professional training 
at the school of Salerno and was afterward appointed the 
personal physician of King Philip Augustus in Paris 
(1180-1223 A. D.), wrote versified treatises on these two 
groups of topics — *'The pulse, the urine, and the beneficial 
characteristics of composite remedies," and ''The signs 
and symptoms of the different maladies." Both of these 
treatises were received everywhere throughout Europe 
with great favor and they maintained their popularity for 
a period of over four centuries. A French translation (by 
C. Vieillard) of the treatise on urology was published in 
Paris in 1903. An edition of the '^De signis et symptoma- 
tihus aegritudinum^^ was printed in Leipzig in 1907. The 
following five lines are quoted by Neuburger; and they 
certainly display the remarkable gift possessed by Aegidius 
for condensing a large amount of information into a very 
small space: — 

DE CONDITIONIBUS URINAE 

Quale, quid, aut quid in hoc, quantum, quotiens, uhi, quando, 

Aetas, natura, sexus, labor, ira, diacta, 

Cura, fames, motus, lavacrum, cibus, unctio, potus, 

Debent artifici certa ratione notari. 

Si eupit urinae judex consultus haberi. 



256 GROWTH OF MEDICINE 

To translate this into easily comprehensible English 
prose would certainly require the employment of at least 
five times as many words. 

Another physician who received a part of his training 
at Salerno and who is mentioned by Neuburger as *'The 
greatest eye surgeon of the Middle Ages," is Benevenutus 
Grapheus (twelfth century), a native of Jerusalem, and 
probably of Jewish parentage. He wrote a practical 
treatise {^'Practica oculorum^') which had a wide circula- 
tion, and which has been translated into Provengal, French 
and English. 

Toward the end of the thirteenth century the famous Med- 
ical School of Salerno began to show signs of decadence. 
Various circumstances were responsible for this change. 
In the first place, its career of great usefulness had already 
covered a period of about seven hundred years, and — 
according to the law affecting all things human — its time 
of decrepitude was already more than due. Then, in the 
next place, vigorous rivals were beginning to appear in 
different parts of Europe, — at Bologna, at Montpellier and 
at Paris, — and these new schools must have attracted large 
numbers of students who otherwise would have frequented 
the University of Salerno for the educational facilities 
which they required. Commercialism — ^if such a term may 
be employed to characterize the action of those who were 
not willing to undergo the entire course of training 
required for obtaining the full privileges belonging to a 
physician — may perhaps also be named as one of the 
influences which contributed to the slow breaking up of 
the school. That this force had already begun to exert 
some effect upon the management of the institution may 
be inferred from the fact that in 1140 A. D., Roger, King 
of Sicily and Naples, promulgated the law that nobody 
would be permitted to practice medicine in his kingdom 
until he should have satisfied the royal authorities that he 
was properly qualified to undertake such practice. The 
establishment of such a law surely indicated that the 
number of those who were incompetent to assume the 
responsibilities of a practitioner of medicine was alarm- 



MEDICAL INSTRUCTION AT SALERNO 257 

ingly on the increase; and, after it had gone into effect, 
many must have been deterred from choosing a medical 
career, and perhaps others have been diverted to schools 
which were located in countries where the laws were more 
lax. In 1240 A. D. the Eoman Emperor Frederic II., who 
was also King of Sicily, made it a law that the course of 
medical studies at Salerno should cover a period of five 
years. All these factors taken together would seem to have 
been sufficient slowly to diminish the popularity of this 
celebrated school. But to these there were added, in the 
latter half of the thirteenth century, — if we may believe 
Puschmann, — two new factors, which exerted a powerful 
influence in destroying all hope of further regeneration, 
viz., the establishment of a university at Naples, in 1258 
A. D., by Manfred, King of Sicily, and the narrow and 
illiberal spirit in which the Church, by this time in almost 
full control of the education at Salerno, managed the 
medical school. 

During the following four centuries the University of 
Salerno — for during the thirteenth century it became a 
university in fact, if not in name — retrograded steadily, 
until finally the French Government, on November 29, 1811, 
officially put an end to its existence. The traveler who 
to-day visits Salerno, in the hope of seeing some remains 
of the oldest medical school in Europe, will find there only 
a collection of squalid buildings which serve as dwellings 
for the poorer classes, a dirty and uncomfortable inn, and 
shops of nearly the same dimensions as those which once 
lined the narrow streets of Pompeii. As he gazes, how- 
ever, at the superb view presented by the Gulf of Salerno 
he may readily, by an effort of the imagination, reconstruct 
the picture of the famous * * Hippocratic City" as it was 
when William the Conqueror and other distinguished 
persons visited it nearly a thousand years ago. 

Neuburger, in his review of the career of the Salerno 
Medical School, sums up its contributions to the science 
of medicine in about these terms: Those who taught at 
Salerno were the first physicians in the Christian part of 
Western Europe who procured for medicine a home in 



258 GROWTH OF MEDICINE 

which scientific considerations alone prevailed, where the 
Church exercised no control whatever, and where all the 
different branches of the science were favored to an equal 
degree. They devoted their best energies, by oral teaching 
and by their writings, to the single object of communicating 
practical knowledge of the healing art to all who desired 
to obtain it; and, by the admirable example of their own 
lives, they furnished a high standard for the guidance 
of those who wished to reflect honor upon the name of 
physician. 



^ 



CHAPTER XXII 

EARLY EVIDENCES OF THE INFLUENCE OF THE 
RENAISSANCE UPON THE PROGRESS OF MEDI- 
CINE IN WESTERN EUROPE 

In previous chapters we have seen how the Arabs, 
inspired with an extraordinary zeal for acquiring knowl- 
edge of the different sciences, devoted time and money 
freely, throughout a period of several centuries, to the 
accomplishment of this purpose. They were fired with 
ambition to become a great nation, and their studies of the 
world's history taught them that the ancient Greeks had 
accumulated in their literature vast stores of the very 
knowledge which they were so anxious to acquire. Accord- 
ingly all their energies were directed toward converting 
these stores from the Greek into their own language, the 
Arabic. This widespread eagerness of the nation, at a given 
period of its history, to improve itself intellectually is 
spoken of as the Arabic Renaissance, and, at the time which 
I am now about to consider, the movement had practically 
come to a standstill. A short time, however, before this 
occurred, the physicians of Italy and of the more northerly 
countries of Western Europe began to show a similar 
desire to add to their medical literature; and their first 
step, like that of the Arabs four or five centuries earlier, 
was directed to the work of translating Arabic medical 
treatises into debased Latin, which was the language 
commonly employed by the learned during the Middle 
Ages. The knowledge which they desired to acquire could 
not at that time be obtained in any other way, for nobody 
was acquainted with the Greek language, and, besides, 
Greek originals had not yet been brought into Western 



260 GROWTH OF MEDICINE 

Europe. These first evidences of the Renaissance in that 
part of the world were not confined to physicians; they 
were to be found in every walk of life. The development 
of the movement reminds one of what takes place near the 
sea coast, where a period of heat and calm is suddenly 
broken by the appearance of a few gentle puffs of wind, 
which are quickly succeeded by the full force of a steady 
and refreshing sea-breeze. In like manner feeble indica- 
tions of the coming movement appeared in Italy, France, 
Germany and even England, and these were soon followed 
by unmistakable evidences that a genuine Renaissance of 
widespread proportions had begun. It was as if a great 
awakening had taken place among the nations which had 
for centuries lain dormant; an awakening which was 
followed by a desire to lay aside the trivial pursuits in 
which they had so far been engaged, and to attain those 
results which were, later on, to excite the wonder and 
admiration of the world. Such were, for example, the 
development of the art of printing ^4th movable types; 
the discovery of America; the production of such clever 
painters, sculptors, engravers, workers in metal, etc., as 
Michael Angelo, Raphael, Albrecht Diirer, Benvenuto 
Cellini, Rembrandt, and literally scores of others of nearly 
equal merit; the development of a Shakespeare, a Milton 
and a Dante in the field of literature ; the production of a 
Luther, a man who had the courage to protest against evil 
practices which had crept into the Christian church. And 
medicine, as I have already stated, felt the influence of 
the approaching Renaissance, and responded to it by 
eJEforts which had for their object the acquisition of such 
knowledge as might be furnished by translations from 
Arabic treatises. Constantinus, the African, of whom 
mention has been made on a previous page, seems to have 
been the first person (toward the end of the eleventh cen- 
tury) who did any work of this kind; but his associates in 
Salerno do not appear to have valued these translations 
very highly, or else, perhaps, they were not yet prepared 
to give serious consideration to works which were new to 
them. In the twelfth century, as will now be seen, the 



INFLUENCE OF THE RENAISSANCE 261 

attitude of the physicians of Western Europe underwent 
a change. 

The city of Toledo, in Spain, was richly stocked with 
the manuscript treasures of Arabic literature at the time 
(1085 A. D.) when it fell into the hands of the Christians. 
One of the earliest scholars to engage in the work of trans- 
lating these treasures into Latin was Gerard of Cremona, 
in Lombardy, who lived during the twelfth century (1114- 
1187 A. D.). He spent most of his lifetime in Toledo, 
* learning and teaching, reading and translating." (Neu- 
burger.) Among the medical works which he translated 
from the Arabic the most important are the following: 
Several of the writings of Hippocrates and Galen; the 
Breviarium of Serapion ; several of the writings of Rhazes 
and of Isaac Judaeus ; the treatise on surgery by Abulcasis ; 
the Canon of Avicenna, etc. This stimulated many others 
to follow in the footsteps of Gerard of Cremona ; and thus, 
during the thirteenth century, a number of works of 
importance were translated in addition to those already 
mentioned. Such, for example, were the **Colliget" of 
Averroes by Bonacosa, a Jew (1255) of Padua; the 
^'Te'issir" of Avenzoar, and the ''Dietetics" of Maimonides 
by John of Capua, a Jewish convert to Christianity (1262- 
1278) ; the ''Z>e veribus cordis" of Avicenna by Arnaldus 
of Villanova (about 1282); the treatise '^De simplicihus" 
of Serapion the Younger, and the ^^ Liber servitoris^^ of 
Abulcasis, by Simon Januensis; and many others. This 
wave of keen interest in the writings of Arabic physicians 
and in the Arabic versions of Greek medical authors soon 
reached Languedoc in France, and then passed over from 
there into Italy. For a long time the Salerno physicians 
resisted its influence, but they finally yielded to it, as the 
leaders in the schools of Bologna, Naples, Montpellier and 
Paris had already done. It was at Palermo, in Sicily, 
however, that the movement received its greatest impetus. 
Frederick II., at that time King of Sicily, and a ruler who 
was most tolerant in religious matters, had at his Court 
an entire staff of Arabic physicians, philosophers, astrolo- 
gers and poets; and, in addition, he kept a number of 



262 GROWTH OF MEDICINE 

learned Christians and Jews constantly busy translating 
Arabic works into Latin. The most widely known member 
of the latter group was Michael Scotus (or Scottus), who 
at one time had been a teacher in the Medical School of 
Salerno. Among the books which he translated while he 
was at Palermo there were several of Aristotle 's treatises, 
more particularly those which dealt with psychological 
topics and with natural history. Frederick not only did 
everything in his power to promote the work of trans- 
lating, he also took pains to distribute copies of the Latin 
versions, when completed, among the universities of 
Western Europe. His son, Manfred, who succeeded him 
on the throne, seems to have been almost as much interested 
in the work as his father had been. It was from him, for 
example, that the University of Paris received a set of the 
Aristotle volumes in Latin. When Charles I., King of 
Naples (1265-1285 A. D.), conquered Sicily he manifested 
considerable interest in continuing the work of his prede- 
cessors, particularly as regards treatises relating to medi- 
cine. Among the translators whom he employed for this 
work was Farragut (in Arabic, Faradsch ben Salem), from 
Girgenti, a small town on the south coast of Sicily, about 
sixty miles from Palermo. In addition to several treatises 
of minor importance he translated into Latin the colossal 
work of Rhazes — the ' ' Continens. " Charles I. kept at his 
Court not only expert translators, but also skilled illumi- 
nators ; and it was by them that the celebrated manuscript 
copy of this work which is to-day in the Bibliotheque 
Nationale at Paris, was illustrated with miniatures, three 
of which are portraits of Farragut. This particular copy 
of the *'Continens" was completed in 1282 A. D. Not a 
few of the translations made during this period, it should 
be stated, are now very difficult to understand. In the first, 
place, the Latin in which they are written is of the barbaric 
type (neo-Latin), something quite different from that 
employed by Cicero, Tacitus and other Roman authors of 
the classical period ; and, in the next, it is not infrequently 
evident that the translator himself did not clearly appre- 
hend the meaning of the original Arabic text. Despite all 



INFLUENCE OF THE RENAISSANCE 263 

these drawbacks, however, the placing of Latin versions 
of Arabic writings within the reach of European physicians 
accomplished much good. Even the imperfections to which 
reference has just been made probably served to increase 
the eagerness of these men to gain access to the real sources 
of Arabic learning — ^viz., the writings in the original Greek. 
To anticipate a little, I may say here that this object was 
not attained until after the lapse of about two more cen- 
turies — that is, not until the scholars of Western Europe 
had learned to read the Greek, and had also brought out 
from their hiding places in churches and monasteries of 
the East the needed originals. At that period of the world's 
history centuries corresponded to decades as modern 
events are recorded. 

One may gain some idea of the extent to which these 
Latin translations of Arabic original treatises and of 
Arabic versions of Greek medical works influenced the 
physicians of Western Europe, by consulting one of the 
important medical treatises of the fourteenth century — 
that, for example, of Guy de Chauliac (written 1363 A. D.). 
Edouard Nicaise, the accomplished editor of this and 
several other mediaeval medical treatises, has printed in 
his preface Joubert's table showing just how often Guy 
quotes each one of about four score earlier authors, and 
from this analysis it appears that Abulcasis was quoted 
175 times, Aristotle 62 times, Avicenna 661 times, Galen 
890 times, Haly Abbas 149 times, Mesne 61 times, Hip- 
pocrates 120 times, and Ehazes 161 times ; or, to state the 
facts somewhat differently, the quotations from treatises 
introduced into Western Europe by the Arabs represent, 
in the present instance, 70 per cent of all the quotations 
(2279 of a total of 3243) made by this author. Another 
equally strong piece of evidence is that afforded by Vincent 
de Beauvais' encyclopaedia, — a work published in Paris 
toward the middle of the thirteenth century, — in which the 
parts relating to medicine appear to have been taken very 
largely from treatises written by Arabic authors. (See 
statement on page 270. ) There can therefore be no reason- 
able doubt that the Arabs played a most important part 



264 GROWTH OF MEDICINE 

in the renaissance of medical learning which began a cen- 
tury or two earlier, which already in the thirteenth century 
had made great progress, and which very soon — as time is 
reckoned in the calendar of all important world move- 
ments — was to culminate in that still greater renaissance 
called '* modern medicine." 

During the later portion of the Middle Ages (thirteenth 
and fourteenth centuries) there were four universities 
which possessed medical schools of considerable impor- 
tance — viz., those of Bologna and Padua in Italy, and those 
of Montpellier and Paris in France. All of these seats of 
learning, like the famous school at Salerno, developed so 
gradually and from such modest beginnings that it is 
scarcely possible to assign to any of them a date of origin. 
Medicine was taught at several other places — as, for 
instance, at Oxford, England; at Naples, Vicenza, Siena, 
Rome, Florence, Ferrara, Pisa and Pavia, in Italy; at 
Salamanca and Lerida, in Spain; at Prague, in Bohemia; 
at Cologne, in Germany; at Vienna, in Austria, etc. But 
the part which these smaller schools played in the work 
of advancing our knowledge of medicine was certainly of 
far less importance than that which fell to the lot of the 
four institutions just mentioned. 

The University of Montpellier, if not the oldest of the 
four schools mentioned, was apparently the first to attain 
some degree of celebrity. It is known, for example, that 
the Archbishop of Lyons, who was suffering at the time 
from some malady which the physicians of that city were 
not able to cure, visited Montpellier 1153 A. D. in the belief 
that he might there obtain the desired relief. John of 
Salisbury, who lived during the latter half of the twelfth 
century and who was considered one of the greatest 
scholars of his time, declared that those who wished to 
acquire a satisfactory knowledge of medicine, found that 
Salerno and Montpellier were the only places where the 
desired instruction might be obtained. Gilles de Corbeil 
(mentioned in the last chapter). Von der Aue, and other 
eminent men of the same period spoke in equally favorable 
terms of the merits of Montpellier. The celebrated monk, 



INFLUENCE OF THE RENAISSANCE 265 

Caesarius of Heisterbach, calls the university of that city 
''the headquarters of medical wisdom"; but at the same 
time he expresses regret that the physicians of that school 
not only do not believe in miraculous cures, but speak of 
them ironically. It was one of the characteristics of the 
institution that the teachers, both the medical and the 
philosophical, were, at a very early period, allowed great 
freedom of thought and speech; but, as time went on, this 
liberty became very much curtailed. During the thirteenth 
and fourteenth centuries there were, it appears, many Jews 
among the students at Montpellier, not merely in the 
department of medicine, but also in the other departments 
of the university. 

The medical schools of Salerno and Montpellier seemed, 
at this early period (thirteenth century), to possess more 
individuality than did the similar organizations at Bologna, 
Padua and Paris ; for limited periods of time each of them 
in turn enjoyed a certain amount of fame by reason of the 
fact that some teacher or writer of special distinction 
happened then to be officially connected with the school. 
In other words, it was the fame of the man and not of the 
school, that induced students to visit Bologna or Padua, 
or Paris, during the thirteenth and fourteenth centuries. 
At a somewhat later period (fifteenth and sixteenth cen- 
turies) all three of these institutions stood out prominently 
before the world as celebrated medical schools, with dis- 
tinctive characteristics. To be invited to occupy a chair 
in one of these institutions conferred honorable distinction 
upon the incumbent selected, and when I reach that period, 
farther on in this history, I shall describe each one of the 
more important schools separately. In dealing with the 
earlier epoch, however, it seems best to devote our attention 
more particularly to individual physicians than to the 
schools with which they may happen to be connected. 

Among the physicians belonging to the latter half of the 
thirteenth and the first quarter of the fourteenth century 
there is one whose proper place in the history of medicine 
is by no means easy to determine, and who yet played a 
part of no small importance. This man was Pietro 



266 GROWTH OF MEDICINE 

d'Abano, or Petrus Aponensis, who was born at Abano, a 
small village near Padua, 1250 A. D. Very little is known 
about his early youth, but from this little we are warranted 
in drawing the conclusion that his father, a notary, must 
have taken great pains to afford him every possible educa- 
tional advantage. He gave his son, for example, the 
opportunity of studying Greek in Constantinople, — a thing 
of rare occurrence in those early days, — and allowed him 
to remain there until he had so far mastered the language 
that he was able to translate the ^^Problemata" of Aris- 
totle from the original text. Then, upon his return home 
from Constantinople, he was sent to Paris for the purpose 
of perfecting his knowledge of philosophy, mathematics 
and medicine. After this thorough training for his life 
work, Pietro d 'Abano began teaching philosophy in Padua, 
and almost immediately he gained such success that people 
spoke of him as **the great Lombard." However, like 
most of the men of that time who became conspicuous 
through their intellectual attainments, Pietro d 'Abano was 
soon accused by the Dominicans of being a heretic and of 
cultivating the magician's art. He was able to parry this 
blow by making a journey to Rome and obtaining from 
Pope Boniface VIII. a decree of absolution. About the 
same time he began writing his two great works — the 
^^Conciliator" and the ''Commentaries on Aristotle's 
Problemata." He did not begin to teach medicine at the 
University of Padua until 1306, when he was already fifty- 
six years of age. But his lectures, reflecting as they did 
the depth and extent of his learning and the keenness of 
his powers of analysis, were a source of great astonishment 
to his contemporaries. It is reported by Neuburger, for 
example, that Gentile da Foligno, one of the most distin- 
guished professors in the Medical School of Padua, 
happening to pass near the auditorium while Pietro 
d 'Abano was delivering his lecture, listened for a short 
time and then exclaimed: ^^ Salve o santo tempio'^ — ''Hail 
to this time which has brought forth such wonders ! ' ' With 
the increase of Pietro 's fame came also a decided increase 
in the bitterness of the persecution carried on against him 



INFLUENCE OF THE RENAISSANCE 267 

by his ecclesiastical foes, largely due perhaps to his open 
and courageous defense of the Averroism which they so 
much hated. There is very little doubt that he would have 
been burned at the stake about this time if the friendly 
disposition of the Popes and the mighty influence pos- 
sessed by the city of Padua had not shielded him from this 
danger. In 1314 the newly founded school of Treviso 
invited Pietro d'Abano to occupy the Chair of Medicine 
and Physics, and he accepted ; but he was taken ill and died 
during the following year. Shortly before the occurrence 
of this event he was placed on trial for heresy by the 
Inquisition, and the proceedings were continued even after 
his death. Indeed, according to one account of this famous 
trial, not only was the charge sustained, but the prescribed 
penalty was inflicted either upon the disinterred corpse 
or upon an effigy of the condemned man. One century later, 
the city of Padua erected a permanent memorial in Pietro 
d'Abano's honor. 

The principal work of this remarkable physician — viz., 
the ^^Conciliator differ entiarium philosophorum et prae- 
cipue medicorum^^ — was first printed at Venice in 1471. 
(It is said to be one of the earliest printed books known.) 
It was a most popular treatise, as is shown by the fact that 
between the year last mentioned and 1621 it passed through 
a number of editions. Of the other treatises which he 
wrote — some seven or eight in all — it will be sufficient to 
mention here that one alone to which reference has already 
been made in the preceding account, viz., the work entitled 
'^Expositio prohlematum Aristotelis^^ (Mantua, 1475, and 
Paris, 1520). 

At this early period in the history of the Padua Medical 
School there were one or two other men who attained a 
considerable degree of celebrity for the excellence of the 
work which they did, either as authors or as class-room 
teachers. A brief account of one of these, Aegidius 
Corboliensis, has already been given on a preceding page, 
and it seems only fair that I should furnish here similar 
brief accounts of some of the others — Gentile da Foligno, 
Massilio and Galeazzo de St. Sophia, Giacomo and Giovanni 



268 GROWTH OF MEDICINE 

de' Dondi, and Giacomo della Torre, from Forli, all of 
whom contributed greatly to the steadily increasing fame 
of the Padua School of Medicine ; but, under the conditions 
which govern the preparation of this brief history, I must 
reluctantly pass over these names in silence. 



CHAPTER XXIII 

FURTHER PROGRESS OF MEDICINE AND SUR- 
GERY IN WESTERN EUROPE DURING THE 
THIRTEENTH, FOURTEENTH AND A PART OF 
THE FIFTEENTH CENTURIES 

Among the men who, during the thirteenth century, 
exerted more or less influence upon the growth of medical 
knowledge there are three who deserve to receive some 
consideration at our hands. They were not physicians, 
but yet some of their writings deal with topics which are 
closely related to the science of medicine. They are: 
Albert von BoUstadt, a German who is generally known 
as Albertus Magnus, one of the greatest scholastic philoso- 
phers of the Middle Ages ; Vincent of Beauvais ( Vincentius 
Bellovacensis), a French Dominican monk, who was reader 
to Louis IX., and who compiled a general encyclopaedia 
which brought him great fame at that period; and Roger 
Bacon, an Englishman who, by reason of the extraordinary 
extent of his knowledge and his remarkable powers of 
observation, was given the name of ** Doctor mirabilis." 

Albertus Magnus. — ^Albertus Magnus was born at 
Lauingen, Swabia, in 1193 A. D., obtained his education 
in Italy (at the University of Padua, during the latter part 
of his stay), joined the Order of the Dominicans on arriving 
at the age of thirty, and afterwards, throughout his long 
life, devoted himself largely to teaching, particularly at 
Paris and Cologne. He was a prolific writer and his works, 
particularly those which treat of topics belonging to the 
domain of natural history, were greatly appreciated. The 
eifect, however, which they produced upon a certain class 
of readers was to persuade them that he was a great 



270 GROWTH OF MEDICINE 

magician. The chief distinction of his writings lies in the 
fact that they contain a large number of original observa- 
tions which he made during the course of his journeys 
afoot through Germany in the character of Provincial of 
the Dominican Order. This habit of exercising entire 
independence in the use of his reasoning powers was some- 
thing quite rare in those days. His observations were 
directed chiefly to matters belonging to the domains of 
zoology, botany, climatology, mineralogy, chemistry and 
physics. The following significant advice, says Neuburger, 
is attributed to him: **As regards the doctrines which 
relate to questions of belief and of morality, it is the part 
of wisdom to attach greater authority to Saint Augustine 
than to the philosophers; in matters belonging to the 
domain of medicine put your chief trust in Galen and in 
Hippocrates ; in natural history, however, your best guide 
is Aristotle." Neuburger adds that, throughout the writ- 
ings of Albertus Magnus, there appear interesting state- 
ments relating to anatomy, physiology, psychology, and the 
plants and minerals which may be used for remedial 
purposes. 

An edition of the writings of Albertus Magnus (21 folio 
volumes) was published in Lyons by Petrus Jamy in 1651. 
The work was republished in Paris in 1892 and following 
years. 

Vincent of Beauvais. — Vincent of Beauvais, France, a 
Dominican monk who lived during the first half of the thir- 
teenth century and was the tutor of Louis the Ninth's 
children, devoted the major part of his time to literary work. 
He wrote many theological treatises and also edited a large 
encyclopaedia in which information is furnished regarding 
everything that was known at that time. Several hundred 
authors aided him in compiling this work, which is entitled 
^^ Speculum Ma jus/' It is arranged in three parts, one of 
which {^^ Speculum Naturale^') consists of 33 books that are 
divided into 3740 chapters; and quite a number of the 
divisions are devoted to topics relating to medicine. The 
authors, from whose writings this medical information has 
been abstracted, are Hippocrates, Aristotle, Dioscorides, 



FURTHER PROGRESS OF MEDICINE 271 

Haly Abbas, Rbazes, Avicenna and several others — not to 
mention the Church Fathers and other encyclopaedic writers 
connected with the Church. The first printed edition of this 
great work appeared toward the end of the fifteenth century 
(1473-1475 A. D.) ; the last, or one of the last, in 1624. Lack 
of space will not permit me to give any details concerning 
the works of a somewhat similar character which were 
prepared, about the same time, by the English Franciscan 
monk Bartholomaeus of Glan villa (1260) ; by the Dominican, 
Thomas of Cantimpre (1204-1280 A. D.), a pupil of Albertus 
Magnus ; and by others. 

Roger Bacon. — Roger Bacon was born about 1210 A. D. 
in Ilchester, Somersetshire, England, and received his early 
training at Oxford. When he was thirty years of age he 
went to Paris and, after devoting himself assiduously for 
seven years to the study of various branches of learning, he 
received the Doctor's degree (1247). The wish to acquire 
a thorough knowledge of whatever subject he undertook to 
study constituted a prominent feature of his character. He 
was fond of languages, but he had an even greater love for 
mathematics, particularly in connection with astronomy, and 
for experimental work in the department of chemistry. It 
is said that he expended a large sum of money (£2000) upon 
these chemical investigations. He left Paris in 1250, 
returned to England, and not long afterward joined the 
Order of the Franciscans. Robert Grossetete, Bishop of 
Lincoln, and the Franciscan monk Adam of Marisco — two 
men whom Neuburger describes as theologians of a very 
liberal type — exercised a strong influence upon Bacon at 
this period of his life. They confirmed him in the belief that 
familiarity with the learned languages was an acquisition 
greatly to be prized, and at the same time they gave him 
every encouragement to pursue his researches in mathe- 
matics and in natural history. For a certain length of time 
he was an instructor at Oxford, but his views with regard 
to ecclesiastic and moral questions and the discoveries which 
he made in physics (especially in optics) were beyond the 
comprehension of his contemporaries, who did not hesitate 
to pronounce them works of the Devil and to subject Bacon 



272 GROWTH OF MEDICINE 

to all sorts of punishments and deprivations. Fortunately 
for him and for the cause of science the newly elected Pope, 
Clement IV. (1266), came to his rescue in those dark days 
and granted him-— under the promise of absolute secrecy — 
permission to continue his researches without hindrance and 
to perfect the plans which he had in mind for reforms of 
different kinds. I cannot follow this pioneer of scientific 
research work, this man who was several centuries ahead 
of the time in which he lived, through all the vicissitudes of 
his interesting and extraordinarily fruitful life; I may 
simply add that his death occurred about the year 1294; 
that he left behind him many important treatises, only a 
small portion of which have thus far been published,^ and 
that from these alone one is justified in classing Roger 
Bacon as one of the greatest thinkers whom history has 
recorded. So far as is now known, he wrote very little 
concerning medicine, and — strange to say — he seems to have 
attached considerable importance to astrology; indeed, he 
went so far as to blame the physicians of his day for their 
ignorance regarding this science, ' ' as a result of which they 
neglect the best part of medicine." In strange contrast 
with these views, which to-day we characterize as foolish- 
ness, is Bacon's famous dictum: *' Experiment is a firmer 
and more trustworthy basis of knowledge than argument" — 
a maxim which is the guiding principle of modern medicine. 

The Medical School of Bologi^a. — The Medical School 
of Bologna first began to assume a certain degree of promi- 
nence in the early part of the thirteenth century, under the 
teaching of Thaddeus Alderotti — also frequently called 
Thaddeus of Florence. 

Thaddeus Alderotti. — Thaddeus Alderotti, who was born 
at Florence, Italy, 1223 A. D., of humble parentage, began 
the study of philosophy and medicine at Bologna only after 
he had reached manhood ; but he was such an earnest student 
and made such good use of his opportunities that in 1260 
he was chosen to serve as one of the teachers in the school. 
Throughout a period of many years he filled the office so 

iThe Opus majus, ed. J, H. Bridges, Oxford, 1897 (2d edition, 1900); 
opera hactenus inedita, ed. B. Steele, Fasc. I., London. 



FURTHER PROGRESS OF MEDICINE 273 

acceptably that his colleagues bestowed upon him the name 
of ''Master of Physicians." Before this time arrived, 
however, his lack of funds was sorely felt, for he was 
obliged, in order to support himself, to offer consecrated 
wax candles for sale at the entrance of the church. He is 
reported to have been not merely a most learned physician, 
but also a very successful practitioner. He was called into 
consultation from all parts of the country, so highly was 
his opinion valued by other physicians ; and thus in due time 
he accumulated a large fortune. His charges were by no 
means small. It is related, for example, that Pope Hono- 
rius IV. sent for him to come to Rome, and, after the treat- 
ment was completed, paid him a fee of 10,000 gold pieces^ — 
but not until after he had expressed surprise that Thaddeus 
should have charged as much as 100 gold pieces per day for 
his services. To this demurrer on the part of the Pope, 
Thaddeus replied that the petty princes and even the simple 
nobles made no objection to paying him 50 or more gold 
pieces per day. It is scarcely necessary to add that the 
Holy Father did not wish to be outdone by his inferiors. 

Alderotti died 1303 A. D. 

Among the writings of Thaddeus Alderotti which have 
come down to our time there are to be found a number of 
autobiographical references which are not without interest. 
In one place, for example, he mentions the fact that he 
occasionally walks in his sleep, and then proceeds (in Latin) 
to discuss the phenomenon of sleep-walking as observed in 
his own case. I give here a free translation of the text 
printed in Neuburger 's History : — 

The fourth question which suggests itself is this : Can the senses 
during sleep come into active operation? Touching this fourth 
question I reason thus: It appears as if, when one is asleep, the 
senses must act, for a person may move about without incurring 
any harm when he is in that state, as is often observed in the case 
of those who, like myself, walk in their sleep Further- 
more, it has been remarked that these people are able to harness 
a horse and then to ride the animal safely, — acts which it is not 

2 Aurei. The aureus is said to have been worth about 16 shillings, English 
money. 



274 GROWTH OF MEDICINE 

possible to perform without the aid of the senses. On the other 
hand, Aristotle maintains that a man, when asleep, is not capable 
of using his senses. To this I reply by conceding that during 
sleep a man certainly does not perceive what is going on about 
him. "Wherefore, if you answer me by saying that the mere fact 
of a man's ability to walk while he is asleep furnishes conclusive 
evidence that he possesses his senses, I reply that movements like 
that of walking are not the result of an impression made upon the 
mind ("impressio imaginativa"), but the product of a different 
mechanism, of a nature which permits it to operate during sleep. 

As to the second point to which you call attention — 

that, namely, with regard to the power of bridling and riding a 
horse while one is asleep — I make this reply: These acts are per- 
formed as a result of an impression made upon the mind through 
the working of the imagination, and not as a direct consequence 
of any images created upon the eye ; for, if the sleep-walker happens 
to be in a strange house when the impulse to walk seizes him, he 
will not go to the stable. The route which he is sure to take will 
be one with which he is familiar, as happened in the case of the 
blind teacher who, unaccompanied by any person, walked habit- 
ually through the streets of Bologna. And then, besides, I am 
able to speak from personal experience, for in one of my sleep 
walks I jumped down from an elevation about four feet above the 

ground without awaking from my sleep When, in the 

course of one of these walks, I am exposed to cold, or when I hear 
somebody speaking near me, I refer these phenomena entirely to 
something within myself, and I return to my bed. 

Of the four medical schools to which a brief reference 
was made on a preceding page, that of Bologna was 
probably the first to attain a certain degree of celebrity; 
and it owed this distinction very largely to the work done 
by men who were primarily surgeons, viz. : Hugo of Lucca ; 
Theodoric, Hugo's son; William of Saliceto; and possibly, 
to a very slight extent, Eoland of Parma, who spent only 
a part of his professional life in Bologna. But there was 
one other who, while he was not a surgeon, yet contributed 
very greatly to the fame of the Bologna school and at the 
same time to the real advance in surgical knowledge which 
characterized the work of the men whose names have just 
been mentioned — viz., Mondino. These men, especially 



FURTHER PROGRESS OF MEDICINE 275 

Mondino, cultivated the study of anatomy much more 
earnestly than their rivals at Salerno had ever done, and 
the surgical methods which they adopted were of a more 
scientific character than those practiced by Roger. In the 
treatment of wounds, for example, instead of striving to 
bring about healing by the application of remedies which 
stimulate suppuration, they favored the dry method; in 
which practice they were justified not only by their own 
experience but also by Galen's teaching: ''A dry state 
of the wound approaches more nearly to what may be 
considered the normal condition, whereas a moist state is 
surely unhealthy." {Methodi medend., IV., 5.) As an 
offset to the latter authority the Salerno surgeons quoted 
that particular aphorism of Hippocrates (V., 67) which 
reads: ^^Laxa bona, cruda vero mala.*' — almost the very 
opposite of Galen's doctrine. Then again, the Bologna 
surgeons effected improvements in other directions : They 
materially restricted the use of the red-hot cautery iron, 
and they cast aside as useless many of the complicated 
apparatuses which had previously been employed in the 
treatment of fractures and dislocations. It is evident from 
these facts that the Bologna surgeons were not, as were 
most of the physicians of the twelfth and thirteenth cen- 
turies (Thaddeus of Florence perhaps excepted), slavish 
followers of the ancients or even of the more modern Arabs, 
but men who thought independently and who were not 
afraid to use their own powers of observation. 

Hugo of Lucca. — Hugo Borgognoni, more commonly 
called Hugo of Lucca — was born in that city about the 
middle of the twelfth century, served as municipal physi- 
cian to the city of Bologna, accompanied the Bolognese 
Crusaders on their expedition to Syria and Egypt, was 
present at the siege af Damietta in 1219 A. D., and died a 
short time before 1258, at the age of nearly one hundred. 
He acquired a great reputation as a surgeon and brought 
up several sons who followed in the same walk of life, 
among the number being Theodoric, who gained even 
greater celebrity than his father in the domain of surgery. 
As Hugo himself left no writings of any kind, we are 



276 GROWTH OF MEDICINE 

largely dependent, for a knowledge of his achievements, 
on the treatises which his son Theodoric wrote. From this 
source we learn that Hugo recommended, for use in sur- 
gical operations, the employment of narcotizing sponges 
like those described on page 253, and was also an advocate 
of the plan of treating wounds by the dry method (com- 
presses soaked in wine over which simple dressings were 
applied). In the treatment of empyema, of abscesses, of 
penetrating wounds of the chest, and of both complicated 
and simple wounds of the skull, he emphasized the wisdom 
of adopting simple measures, of interfering with the parts 
as little as possible, of abstaining from the use of the probe, 
and of observing strict cleanliness. In cases of fracture 
of a rib it was his practice to place the patient in a bath, 
and then, with fingers which had been thoroughly oiled, to 
attempt the replacement of the separated ends of the 
fractured bone. Neuburger regards Hugo of Lucca as the 
founder of the Bologna School of Surgery. 

Theodoric of Lucca, known also as Bishop Theodoric, 
was born 1206 A. D. While still quite a young man he 
joined the recently established order of preachers, and not 
long afterward was appointed Almoner {PoenitentiariusY 
to Pope Innocent IV. Eventually he became Bishop of 
Cervia, near Eavenna. By special permission of the Pope, 
he was able to complete the surgical training which he had 
received from his father, Hugo of Lucca; and thus, while 
he still held the office of Bishop, he practiced surgery to 
some extent in Bologna. In course of time his practice 
became very extensive and also very lucrative ; as a result 
of which he was able to leave a large fortune to various 
charitable institutions. The first printed edition of his 
work on surgery appeared in Venice in 1498, and was 
followed by numerous later issues. 

Theodoric, says Neuburger, was a most uncompromising 
advocate of the dry method of treating wounds. His 
( Theodoric 's) words are these: *'For it is not necessary — 
as Eoger and Roland have said, as most of their disciples 

3 A church official to whom was intrusted the duty of granting dispensa- 
tions; "Almoner" is perhaps the equivalent term in English. 



FURTHER PROGRESS OF MEDICINE 277 

teach, and as almost all modern surgeons practice — to favor 
the generation of pus in wounds. This doctrine is a very- 
great error. To follow such teaching is simply to put an 
obstacle in the way of nature's efforts, to prolong the 
diseased action, and to prohibit the agglutination and final 
consolidation of the wound."* 

In his enumeration of the different means that may be 
employed for arresting hemorrhage, Theodoric mentions 
cauterization, tamponading, the application of a ligature, 
and the complete division of the injured blood-vessel. He 
attached great importance to the proper feeding of the 
patient. In Book III., chapter 49, of his treatise on sur- 
gery, he gives minute instructions with regard to the proper 
manner of employing a salve made with quicksilver, and 
at the same time he mentions the fact that he observed a 
flow of saliva as one of the results of its use. 

The expressions ''healing by first intention" and ** heal- 
ing by second intention" are encountered for the first time 
in the writings of Brunus, a surgeon who practiced in the 
cities of Verona and Padua about the middle of the thir- 
teenth century, and who was a vigorous advocate of the 
dry method of treating wounds. His two treatises 
{^^Chirurgia magna" and ^'Chirurgia minor ^*) were 
printed in Venice in 1546. Neuburger says that although 
a large part of the text in these volumes consists of 
extracts from Galen, Avicenna, Hippocrates, Abulcasis 
and other authorities, there are to be found at the same 
time not a few observations of an original character. 

William of Saliceto. — William of Saliceto {Guglielmo da 
Saliceto) is accorded by Neuburger the honor of being 
Bologna's greatest surgeon — ^if not, indeed, the greatest 
surgeon of that period. He was born in the early part of 
the thirteenth century and spent a large portion of his 
professional life in Bologna, where he not only practiced 

4 * ' Non enim est necesse saniem — sicut Rogerius et Rolandus scripserunt 
et plerique eorum discipuli docent, et fere omnes cururgici modemi servant — 
in vulneribus generare. Iste enim error est major quam potest esse. Non 
est enim aliud, nisi impedire naturam, prolongare morbum, prohibere con- 
glutinationem et consolidationem vulneris." (IT., cap. 27.) 



278 GROWTH OF MEDICINE 

medicine but also acted in the capacity of a teacher of this 
science. During the latter part of his career he lived in 
Verona, where he held the position of Municipal Physician 
and Attending Physician of the City Hospital. He died 
about the year 1280. 

Saliceto's work on surgery is of a thoroughly practical 
character and reveals the author to have been a born sur- 
geon.^ In addition to the ^^Cyrurgia," which was first 
printed in Piacenza 1476 A. D., he wrote a treatise which 
bears the title ^^Summa conservationis et curationis" 
(printed first in Piacenza in 1475). The ''Surgery" is 
divided into five books, preceded by a short chapter on 
general methods, etc. Book I. is devoted to affections of 
the cranium, eruptions on the head, eye diseases, ear dis- 
eases (snaring of ear polypi), nasal polypi, abscesses in 
the axilla, affections of the mammary gland, tumors in 
different parts of the body, venereal lesions in the groin, 
and a long list of other surgical maladies. Book II. 
describes wounds of all sorts, including those produced by 
arrows (with reports of cases), penetrating wounds of the 
chest and abdomen (with instructions about sewing both 
longitudinal and transverse wounds of the intestine), etc. 
Under the head of penetrating wounds of nerves (declared 
by the author to be very dangerous), Saliceto recommends 
enlargement of the wound, the application of oil, and the 
employment of opium or hyoscyamus to quiet the pain. 
Book III. treats the subject of fractures and dislocations 
in a most thorough manner. Mention is made of the 
crepitation noise heard in fractures {sonitus ossis fracti) 
and a warning is given not to apply the bandages too tightly 
and to be careful to change the dressings every three or 
four days. The instructions given with regard to the 
reduction of dislocations are said by Neuburger to be most 
sensible. Book IV. contains such anatomical descriptions 
as may be helpful to the practical surgeon. From these, 
however, it is evident that the writer had never dissected 
the human cadaver. Book V. is devoted to the subject of 

6 The most recent edition of this work is a French translation made by 
P. Pifteau and published at Toulouse, in 3898, 



FURTHER PROGRESS OF MEDICINE 279 

cauterizing and to the consideration of those remedial 
agents which are commonly employed in surgery. The 
instruments used for cauterizing purposes were made of 
different metals, gold or silver being preferred for the 
more delicate ones, and brass and iron for the others. 
Immediately after the cauterization it was customary to 
apply butter, or the fat of some animal, or oil scented with 
roses, to the burned part. 

Saliceto's other treatise — the Summa conservationis 
etc. — is also divided into five books, which contain chapters 
devoted to all the more important branches of internal 
medicine and to questions of diet, of the physician's 
behavior in the presence of a patient, etc. Especially 
interesting are his remarks about the importance of con- 
sidering the psychological effect produced upon the patient 
by such matters as the physician's manner of feeling the 
pulse, his carefulness to inquire about the patient's various 
symptoms (how the night was passed, what food and drink 
had been taken, etc.) — an effect which oftentimes is 
*' greater than that produced by instruments and medi- 
cines." In discussing the subject of prognosis, Saliceto 
makes the remark that it is always proper for the physician 
to hold out to the patient hope of recovery, although he 
urges at the same time the wisdom of telling the whole 
truth to the friends of the patient. He also lays great 
stress upon the importance of **not holding any conversa- 
tion with the lady of the house upon confidential matters." 
Neuburger gives a number of other extracts from this most 
interesting work; but I must abstain from devoting any 
more space to this one mediaeval author, whose manner 
of writing makes it difficult to realize that the treatise which 
he has written belongs to the thirteenth century and not 
to a very recent period. 

Roland of Parma. — Roland, who was born in the city of 
Parma and who spent a part of his life in Bologna, not 
only edited the work of his teacher, Roger of Salerno, but 
also wrote a concise treatise on surgery that is entitled 

Rolandina.^' Neuburger speaks of this book as differing 



II 



280 GROWTH OF MEDICINE 

but little from Eoger's ^^Practica chirurgiae.^^^ "It con- 
tains, however, the report of a case of penetrating wound 
of the chest in which Roland showed not a little courage 
by daring to cut off, flush with the skin, a portion of lung 
tissue which happened to protrude from the wound, and 
then applying a simple dressing." 

The treatise known by the title ^^Glossulae quatuor 
magistrorum super chirurgiam Rogerii et Rolandi" was 
written by an unknown author or perhaps by several 
authors. It represents a collection of commentaries on the 
works of the two who are mentioned in the title of the book, 
and should probably be classed as a part of the literature 
of the Salerno School of Medicine. 

Mondino the Anatomist. — Mondino, who was the first 
physician, after an interval of about fifteen hundred years, 
to revive the practice of dissecting human bodies, was born 
at Bologna at about 1275 A. D. He received his profes- 
sional training at the medical school of his native city and 
was given the degree of Doctor in 1290, at the age of 
fifteen ( !). Not long afterward he began to teach anatomy 
in the same institution and continued to serve in this 
capacity up to the time of his death in 1326. The physicians 
who aided him in his anatomical researches were Ottone 
Agenio Lustrulano, his prosector, and a woman named 
Alessandra Gilliani, from Perriceto. 

Mondino 's method of teaching anatomy was to deliver 
his lectures with the dissected cadaver directly before him ; 
that is, he demonstrated the correctness of his statements 
as fast as he made them. (See Fig. 9.) Such a method 
was entirely new at the time and proved immensely popu- 
lar, attracting students to Bologna in large numbers. 
Partly in this way and partly by means of the treatise on 
anatomy which he wrote {^^Anatomia MundinV^), he 
became the instructor of numerous generations of physi- 
cians. His treatise remained the authoritative guide in 
anatomy up to the middle of the sixteenth century. 

6 According to Daremberg (Histoire des Sciences Medicales, Vol. I., p. 264) 
the title ' ' Doctor ' ' appears for the first time in the Preface of Eoger 's treatise 
(1180 A. D.). 




c 

J.S6- 






FIG. 9. THE OLDEST KNOWN PICTORIAL REPRESENTATION 
OF A FORMAL DISSECTION OF THE HUMAN BODY. 

The original, which is in the library of the University of Montpellier, 
France, appears in a manuscript copy of Guy de Chauliac's Chirurgia magna 
(fourteenth century). Eugen Hollander of Berlin, the author of Die Medi- 
zin in der klassischen Malerei, has courteously given permission to copy the 
reproduction. The many defects which appear in this picture are due to the 
fact that the reproduction was taken directly from the original miniature, 
now six hundred years old. Hollander gives the following description of 
this interesting scene: 

"In one of the rooms of the hospital a woman's dead body is lying 
upon a table. Alongside the bed in which she died a nun is praying 
for her soul. Two physicians are busily engaged in the work of dis- 
secting the body. ^An instructor is reading out of a book, for the 
benefit of the students who are crowding into the room, such por- 
tions of the text as apply to the case in hand, and at the same time 
he is directing their attention to the uterus which one of the dissect- 
ors is Hfting out of the abdominal cavity. Owing to the defective 
state of the original miniature it is not possible to state positively 
what part the three women who stand near the head of the corpse 
are taking in the scene, but it is not unlikely that they too are physi- 
cians, especially as their presence on such an occasion would be quite 
in harmony with the customs of that period of time." 



FURTHER PROGRESS OF MEDICINE 281 

In one place in his ** Anatomy," Mondino states explicitly 
that he dissected two human cadavers in the month of. 
January, 1315. This statement renders it possible to fix 
the exact date when the practice of making such dissec- 
tions — which had been carried on for a considerable period 
of time about 250 B. C. — was first resumed. If one reflects 
upon the nature of the obstacles which in 1315 stood in the 
way of a revival of this practice, — for example, the deep- 
seated prejudice against it entertained by all classes of 
the community, and the very strong opposition of the 
ecclesiastic authorities to what they honestly believed to 
be a desecration of the human body, — one will readily 
appreciate how great was the courage displayed by Mon- 
dino when he almost openly undertook his first dissection. 
The subsequent career of this famous teacher of anatomy 
justifies the belief that his determination to take the course 
which he did was based upon the profound conviction that 
the first step toward increasing the scanty stock of knowl- 
edge possessed at that time with regard to the structure 
of the human body in all its parts, must necessarily be one 
in continuation of that which Erasistratus and his asso- 
ciates had taken centuries earlier, but which had not been 
succeeded by a sufficient number of other steps in the same 
direction. The series of discoveries in anatomy, physi- 
ology and pathology which resulted from Mondino 's 
courageous and intelligent act, form a part of the history 
of modern medicine, and do not therefore call for consid- 
eration in this place. We may simply add that much 
information of a very interesting character is furnished 
by Neuburger {op. cit.) with regard to the manner in which 
Mondino and his immediate successors carried on their 
instruction in anatomy from that time forward. 

The Medical School at Bologna, as may well be imagined, 
gained great fame from the possession of such distinguished 
teachers as those whose careers I have briefly sketched — 
Hugo and Theodoric of Lucca, William of Saliceto, and 
Mondino; and it retained a large part of this celebrity 
throughout the fourteenth and fifteenth centuries, despite 
the appearance on the scene, toward the end of this time, 



282 GROWTH OF MEDICINE 

of several formidable claimants for high honors in the 
domain of medical research and education — viz., the schools 
at Montpellier and Paris, in France, and that of Padua, in 
Italy. 

Lanfranchi and the Medical School of Paris. — According 
to Edouard Mcaise^ medicine was not taught publicly at 
Paris previously to 1160 A. D. The teaching was carried 
on at that time by associations of physicians, and it was 
only during the following century (about 1250 A. D.) that 
something like a university was established in that city. 
Up to the end of the sixteenth century (1595 A. D.), during 
the reign of Henry IV., this institution remained under 
the control of the Church. Its functions — so far at least 
as medicine was concerned — were limited to the bestowing 
of degrees, for it possessed at that time no organization 
of instructors and no permanent quarters in which the 
teaching might be carried on systematically; a church 
(see Fig. 10) or the Dean's residence serving as the locality 
in which the lectures were commonly delivered. 

During the middle part of the thirteenth century and for 
a long time afterward, the practice of surgery, which was 
then of a rather primitive type, was entirely in the hands 
of two classes of men — the barbers and the so-called 
surgeons.* As time went on, the surgeons began to feel 
the necessity of securing better protection for their material 
interests, which were being more and more encroached 
upon by the barbers — a class of men who were not privi- 
leged by the authorities to include in their field of acti^dties 
anything beyond hair-cutting, shaving, cupping, the extrac- 
tion of teeth, the application of leeches, the incision of boils 
and perhaps one or two other simple operations. For this 
reason, therefore, and also probably because they too felt 

T^'La Grande Chirurgie de Chiy de Chauliac," Paris, 1890. 

8 The distinguishing sign of the barbers was the shaving dish, made of 
pewter and hung up at the door of the shop; that employed by the surgeons 
was also a shaving dish, but made of polished brass. Those surgeons who had 
received their training at the school of Saint Cosmas and Saint Damian were 
permitted to display at the window a banner bearing the coat of arms of this 
institution. 



FURTHER PROGRESS OF MEDICINE 283 

in some measure the effects of the Renaissance spirit which 
was then abroad in the land, they organized themselves 
(1254 A. D.) into an association which bore the name of 
''College of Saint Cosmas" {College de St. Come).^ One 
of the early acts of this association was to establish the 
rule that all applicants for membership should pass suc- 
cessfully an examination as to their fitness before they 
could be admitted. Very little is known about the doings 




FIG. 10. THE MANNER OP GIVING PUBLIC INSTRUCTION 
IN MEDICINE DURING THE MIDDLE AGES. 

(From Meaux Saint-Marc's L'Aco/e de Salerne.) 
The present cut is evidently a modern copy of a much earlier original. 



of the organization during the early years of its existence. 
Later, as we shall see, it played a very important part in 
the history of medicine in France. 

» The surgeons Cosmas and Damian were chosen patron saints of the new 
organization. They were born in Arabia in the third century, and are said 
to have been educated there. After having practiced medicine for a certain 
length of time in Sicily, they were tortured and killed, because of their Chris- 
tian faith, by order of the Emperor Diocletian, 303 A, D. Hence the title 
"Saints." 



284 GROWTH OF MEDICINE 

From the account given by Nicaise it appears that no 
regular instruction in anatomy was given in the University 
of Paris until after the fourteenth century, and then only 
from three to five times a year, when the body of a person 
who had been hung was publicly dissected. ''Such a 
dissection lasted seven days and was a veritable scientific 
festival." No official cliniques were held and the only 
way in which the student of medicine could obtain some 
practical acquaintance with disease and with the methods 
of treatment was by attaching himself to a physician or a 
surgeon, or to a barber. 

From the preceding brief and very incomplete account 
the reader will, I trust, be able to form some idea of the 
condition of affairs, medical and surgical, in Paris at the 
time when Lanfranchi arrived in that city. 

Lanfranchi, says Neuburger, was born in Milan, Italy, 
and was undoubtedly the most distinguished among the 
pupils of Saliceto at Bologna. After leaving the medical 
school he practiced both medicine and surgery for a certain 
length of time in his native city; but finally, becoming 
involved in the quarrels between the Guelphs and the 
Ghibellines, he — ^like many other Italian physicians — ^was 
obliged to take refuge in France. In Lyons, which was his 
first place of residence, he engaged for a short time in the 
practice of medicine and also wrote his first treatise on 
surgery — ' ' Chirurgia Parva. ' ' Then, after traveling from 
one place to another in the provinces, he finally (1295 A. D.) 
settled permanently in Paris. In that city he very soon 
acquired a large practice, and, at the same time, built up 
for himself a great reputation as a teacher of medicine. 
The College de St. Come elected him a member of that 
organization and profited greatly from the fame which his 
teaching brought to the institution. It is said that Jean 
Passavant, who was at that time the Dean of the Medical 
Faculty of Paris, aided Lanfranchi in his work by every 
means in his power. As a result Paris, during a consider- 
able period of time, was one of the few places in which 
genuine clinical instruction was given to all those who 
desired to acquire a practical acquaintance with disease. 



FURTHER PROGRESS OF MEDICINE 285 

His larger treatise, the * * Chirurgia Magna, ' ' was completed 
in 1296. It was dedicated to the Eang of France, Philip IV., 
commonly called ^^Phillippe le Bel/' and its intrinsic merits 
assured him a permanent reputation as a surgeon. This 
work, which was translated years ago into English and has 
recently (1894) been published by the ''Early English Text 
Society," under the title *'Lanf rank's Science of Cirurgie," 
consists of five separate fasciculi or parts. A few extracts 
from the text of this celebrated work may prove of interest 
to the reader. Not having access to the English version 
just mentioned, I shall have to translate from the version 
(partly Latin and partly German) supplied by Neuburger. 
Part I. of the Chirurgia Parva mentions some of the 
characteristics which a surgeon should possess. He should, 
for example, have well-formed hands, with fingers that are 
long and slender ; his body should be strong and firm in its 
movements; his hands and fingers should respond quickly 
to the workings of the mind ; his mind should be of a subtle 
type; in character he should not be over-bold, but self- 
reliant and yet modest; he should have a good supply of 
common sense; he should be well-informed not only in 
medicine, but also in all the branches of philosophy; he 
should be a good logician; he should be familiar with the 
writings of medical authors; he should be virtuous and 
ethical; he should be trustworthy; he should not be 

avaricious nor envious; and, finally, he should be 

thoroughly familiar with all the diseases to which the 
human body is liable. In one place Lanfranchi refers to 
the fact that exposure to the air favors the production of 
pus in a wound. Among the methods which may be 
employed for arresting hemorrhage he mentions digital 
compression and ligaturing of the bleeding vessels. He 
recommends that a wounded individual should abstain from 
wine and from an over-nutritious diet. No attempt, he says, 
should be made to extirpate, with the knife or by means 
of the actual cautery, an ulcerated cancer, unless it appears 
probable that by such means complete destruction of the 
tumor may be effected. In traumatic tetanus dependent 



286 GROWTH OF MEDICINE 

upon an injury of a tendon or nerve trunk he recommends 
complete division of the wounded structure. 

Part II. is devoted to the consideration of wounds of the 
different parts of the body, taken in regular order from 
the head to the feet. The descriptions, in each instance, 
are preceded by an adequate account of the region affected. 
In his discussion of fractures of the skull he speaks of the 
diagnostic value of the rough and jarring sound perceived 
by the patient when the physician taps with a rod upon the 
injured skull; and he also states that an aid to diagnosis 
may be derived from the fact that a person whose skull is 
fractured experiences pain at the seat of the injury when 
somebody passes the ends of his finger-nails along a string 
which the patient holds suspended between his teeth.^" 
According to Neuburger the description which Lanfranchi 
gives of the various symptoms observed in cases of fracture 
of the skull is admirable. In the section relating to the 
treatment of such fractures he warns against the tendency 
to resort too readily to the use of the trephine, and 
expresses the belief that this instrument should be employed 
only when the fractured bone is depressed or when there 
is evidence of irritation of the dura mater. 

Part III. deals with skin diseases and various forms of 
tumors, including those of the thyroid gland; and with 
diseases of the eye, the ear and the nasal cavities; with 
the various kinds of hernia; with renal and cystic calculi; 
with hemorrhoids, varicose veins, etc.; with abdominal 
dropsy; and with still other affections. In bloodletting he 
recommends the practice of opening the vein longitudi- 
nally. He is very emphatic in his manner of insisting that 
medicine and surgery should not be divorced, and that the 
operation of drawing blood should not be intrusted to 
barbers. 

After the death or retirement of Lanfranchi during the 
first decade of the fourteenth century, Paris appears to 
have played, at least for a few years, a comparatively small 
part in the history of medical teaching. Her rivals at 

10 Guy de Chauliac, who wrote a treatise on surgery in the latter half of 
the fourteenth century, also speaks of the value of this diagnostic sign. 



FURTHER PROGRESS OF MEDICINE 287 

Montpellier, in the south of France, and at Bologna and 
Padua, in Italy, far outstripped her during this period. 
There was one physician at Paris, however, — Henri de 
Mondeville, — who would probably have proved a worthy 
successor of Lanfranchi if circumstances had not seriously 
interfered with his acting the part of a teacher. 

Henri de Mondeville. — Henri de Mondeville, says 
Edouard Nicaise, was born about 1260 A. D. in Normandy. 
In his native village — Mondeville or Mandeville, or Amon- 
daville, all of which names are found in the manuscripts — 
he was known simply as Henri, but in the outside world 
and in medical literature he is mentioned, in accordance 
with the prevailing custom of that period, as Henri de 
Mondeville. After studying medicine for a certain length 
of time in Paris and Montpellier, he went to Italy and 
became the pupil of Theodoric of Bologna. He is said to 
have been passionately fond of surgery, which at that 
period was, in France, a much despised branch of medicine. 
In Italy, on the contrary, such men as William of Saliceto, 
Hugo of Lucca, Theodoric and Lanfranchi had raised sur- 
gery to a position of great honor, and Henri de Mondeville 
cherished the hope that he also might be able to accomplish 
the same result in France, Upon his return to Paris he 
was chosen one of the physicians (there were four in all) 
of the royal household, and from that time onward he was 
frequently obliged to set aside, for longer or shorter 
periods, all his personal interests (private practice, lec- 
turing to medical students, hospital service at Hotel-Dieu, 
etc.) in order to attend the King or the Comte de Valois on 
some military expedition. This sort of service, however, 
was by no means time lost, for it afforded him the oppor- 
tunity to acquire great experience in the treatment of 
wounds, an experience which reveals itself on almost every 
page of his treatise on surgery. And yet there came a time 
(1312) when de Mondeville complained bitterly of these 
interruptions, for which he received no pay and which 
interfered seriously with his literary work. Despite these 
hindrances, he appears to have made a fair degree of 
progress in the writing of his book, for at the date last 



288 GROWTH OF MEDICINE 

named lie gave a public reading of the first two sections 
** before a large and noble assemblage of medical students 
and other distinguished personages." The portrait of 
de Mondeville which is here reproduced is a copy of the 
miniature which appears in one of the manuscripts of his 
treatise that was prepared 1314 A. D., and is now preserved 
in the Bibliotheque Nationale at Paris. Nicaise furnishes 
the following details regarding the original miniature. 

Inasmuch as the MS. bears the date 1314 the portrait must have 
been painted while De Mondeville was still living. The master is 
represented wearing a violet-colored gown, red stockings, and a 
black skull-cap. He is thin, his beard is scanty and of a grey 
color like the hair of his head, his features are finely cut, and he 
appears to be a fairly tall man. So far as one may judge from 
this portrait De Mondeville 's age was then about fifty. 

The date of his death is not known exactly, but it must 
have been somewhere about 1320 A. D. 

Nicaise sums up de Mondeville 's personal history and 
his contributions to the science of medicine somewhat as 
follows : He was a man of warm impulses, who loved the 
truth and despised all shams. He never hesitated to speak 
his opinion about others, the King himself not being 
excluded from his criticisms. He wa& also quite frank in 
his exposures of the ignorance of both nobles and members 
of the clergy. He was not in the least degree superstitious. 
He remained unmarried throughout life and seems to have 
entertained a slight disposition to find fault with women, 
for he attacks somewhat violently their mode of life and 
their extravagance, especially in the case of the women of 
Montpellier. Although he possessed a great reputation 
and a very large clientele of patients, he did not acquire 
a fortune. He is quoted as saying: **I was obliged from 
the very first to work hard for a living." Suppuration, 
according to the view of de Mondeville, was not a necessary 
phenomenon in the healing of wounds. 

About the year 1316 the condition of de Mondeville 's 
health — he probably had pulmonary tuberculosis — ^began 
to give him serious cause for anxiety lest he might not live 




FIG. 11. HENRI DE MONDEVILLE. 

(From Nicaise's Version, Paris, 1893.) 

From a miniature at the head of a manuscript which bears the date 
A. D. 1313, now preserved in the Bibliothfeque Nationale at Paris. 



FURTHER PROGRESS OF MEDICINE 289 

long enough to complete his book ; and, as a matter of fact, 
the treatise which we now possess shows that his fears 
proved to be well grounded. The important subjects of 
fractures, dislocations and hernia, for example, are men- 
tioned only casually. Those subjects, however, which he 
did discuss are treated in a very clear and practical manner. 
Thus, for example, his instructions with regard to the 
proper manner of treating wounds is most satisfactory. 
Theodoric and he were the great champions of the so-called 
dry treatment, which had been introduced at some remote 
period of antiquity, but which apparently had not met with 
general acceptance. Then, again, in his remarks on the 
subject of amputations, he taught that the ligaturing of 
the severed arteries after the removal of the amputated 
part, was universally recognized as the proper course to 
adopt and should never be neglected. 

In Chapter VII. of the first section of his treatise, de 
Mondeville gives a description of the anatomy of the heart 
and related blood-vessels, and at the same time furnishes 
an unusually clear account of the physiology of the circu- 
lation which was universally accepted by the physicians 
of that period, as it had already been by those of earlier 
centuries. It seems desirable to reproduce this account 
here in order that it may serve for purposes of comparison 
with that which Harvey was to give three centuries later. 
It is only by making such a comparison that the physicians 
of our time can appreciate the vast importance which 
attaches to Harvey's wonderful discovery. De Monde- 
ville 's account, abbreviated wherever it seemed practicable 
to do this, reads as follows : — 

The heart is the most important of all the organs. It transmits 
to the other members of the body vitalizing blood, heat and spirit. 
Its muscular tissue, unlike ordinary muscle, is composed of three 
kinds of fibres, and it is not under the control of the will. It has 
the shape of a pineapple and is located in the centre of the chest, 
like a prince in the middle of his kingdom. Its lower extremity 
is directed somewhat to the left of the chest, as we are assured by 
the Philosopher (Aristotle) in his history of animals. There are 
two reasons why it points toward the left : 1., in order that it may 



290 GROWTH OF MEDICINE 

not press upon the liver or be pressed upon by it ; and 2., in order 
that it may not communicate its heat to the left side (the cool side) 
of that organ. 

It is important to note the fact that the heart is the only structure 
which contains blood in its substance ; in all the other members of 
the body the blood is contained in the veins. The base of the heart 
is situated at its highest point and represents the broadest portion 
of the organ ; it is attached to the posterior wall of the chest by a 
few ligaments, than which no stronger are to be found in any part 
of the body. These bands do not touch the heart at any point 
except at the top, where they take their origin; and their great 
strength is explained by the fact that it is their duty to hold the 
heart firmly in its proper position. 

The heart possesses two ventricles or cavities, of which the left 
one — by reason of the natural position of the organ as a whole — 
is a little higher than the right. Between these two cavities there 
is placed a partition which in its turn contains a small cavity — 
termed by some the third ventricle. Above each of the larger 
ventricles there is a sort of appendix — cartilaginous in structure, 
but flexible and at the same time strong, — which contains a cavity 
and has some resemblance to a cat's ear. These structures, to 
which the common people have given the name auricles, alternately 
contract and dilate. The purpose for which they exist is to serve 
as reservoirs for the blood and air that are needed for the nourish 
ment and cooling of the heart. 

To the right ventricle there comes a many-branched vein which 
conducts to the heart a coarse, thick and warm blood destined to 
nourish that organ. The portion of this abundant fluid which is 
not needed for this purpose is then rendered less coarse and thick 
by some subtle power possessed by the heart itself, after which it 
is driven into the cavity that is located within the partition wall 
which separates the ventricles the one from the other. From this 
smaller cavity, this so-called third ventricle, in which it receives 
additional heat and at the same time undergoes further thinning 
as well as some kind of digestion and purification, the blood passes 
on into the left ventricle and there undergoes a further change — 
one which is characterized by the development of that element 
which we call spirit, something clearer, more subtle, more pure, 
more glorious than any known substance in the human body, 
and therefore more nearly allied in its nature to celestial things. 
This new element forms a friendly and very appropriate link 
between the body and the soul ; it is the direct agent or instrument 



FURTHER PROGRESS OF MEDICINE 291 

of the latter, conveying to man the different faculties with which 
he may be endowed. 

From the left ventricle of the heart, alongside its auricle, two 
arteries are given off. One of them, which is only furnished with 
one tunic (as in the case of a vein) and which is called the arteria 
venalis (pulmonary vein), carries to the lungs the blood which 
they require for their nourishment, and breaks up into many 
branches after entering these structures; the other artery is pro- 
vided with two tunics and is called the grand artery (the aorta). 
From the latter vessel are given off the numberless arteries which 
are distributed throughout the entire body — ^vessels which trans- 
port to every organ and structure both the blood which they need 
for their nourishment and the spirit required for their revivifica- 
tion. When this spirit passes into the ventricles of the brain it 
is subjected to a new species of digestion, which converts it into 
the spirit of the soul. Similarly, when it enters the liver it becomes 
a nutritive spirit; when it enters the testicles, a generative spirit, 
and so on through all the different organs. 



CHAPTER XXIV 

DURING THE LATTER HALF OF THE MIDDLE 
AGES SURGERY ASSUMES THE MOST PROMI- 
NENT PLACE IN THE ADVANCE OF MEDICAL 
SCIENCE 

During the first half of the fourteenth century, as has 
been shown in the preceding chapter, Henri de Mondeville 
was largely successful in rendering Paris the most promi- 
nent centre of medical activity in France, if not in Western 
Europe generally. His life, however, was short, and his 
position as one of the leading surgeons of the French Army 
subjected him to many and prolonged interruptions, for 
which reasons he was not able to complete his excellent 
treatise on surgery. No physician of the same intellectual 
capacity and of equally strong character appears to have 
been living in Paris at the time of De Mondeville 's death, 
and consequently the importance of that city as a centre 
of medical education diminished rapidly after that event. 
On the other hand, the Medical School at Montpellier in 
the southern part of France began at about this period, 
under the influence of Arnold of Villanova (probably a 
small town in Catalonia, Spain, in the diocese of Valencia), 
to acquire importance. 

Arnold of Villanova and the Medical School of Mont- 
pellier. — Arnold of Villanova was born about 1240 A. D., 
of humble parentage. He obtained his early education in 
a Dominican cloister, and afterward devoted all his energies 
to the study of languages (especially Hebrew), theology, 
philosophy, the natural sciences (physics, alchemy), and 
medicine. Paris and Montpellier were the principal cities 
in which he prosecuted those studies. Already as early 



ADVANCE OF SURGERY 293 

as the year 1270, Arnold had attained considerable celeb- 
rity as a physician. Between the years 1289 and 1299 he 
appears to have made his home in Montpellier, and to have 
been very actively engaged both as a practicing physician 
and as a teacher of medicine. It was in that city also that 
he wrote the more important of his numerous medical 
treatises. At a later period of his life he appears largely 
to have lost his interest in medicine, for in 1299 we find 
him acting as an ambassador from the King of Aragon, 
whose private physician he was, to the Court of Philippe 
le Bel, King of France, and deeply entangled, during his 
stay in Paris, in disputes with the theologians of that city 
respecting certain religious doctrines. He was also at the 
same time busily engaged in championing various eccle- 
siastic reforms which he was anxious to see inaugurated. 
His opponents haled him before the tribunal of the 
Inquisition and succeeded in having him cast into prison, 
where he remained until he expressed a willingness to 
retract the obnoxious opinions which he had advanced. 
The same tribunal pronounced his treatise '*Z)e Adventu 
Antichrists^ to be heretical. After these persecutions 
Arnold endeavored to procure aid and comfort from Popes 
Boniface VIII. and Benedict XI. The former was inclined 
in his favor, but Benedict manifested no disposition to aid 
him. Boniface's sentiments were doubtless influenced by 
the fact that Arnold had treated him successfully for stone 
in the bladder; and Neuburger incidentally states that, in 
the effecting of this cure, not only medical and dietetic 
treatment had been employed, but also two other meas- 
ures — viz., the application of a bandage or truss which 
encircled the loins snugly, and the wearing (by the patient) 
of a magic seal ring upon which was engraved the effigy 
of a lion.^ When Pope Clement V. (1305-1315 A. D.) 
removed the papal seat from Rome to Avignon, in France, 
Arnold was relieved from the charge of heresy and 
reinstated in the respect of his contemporaries. He became 
the trusted adviser of royalty, won the sympathy of 
Jayme II. and of his brother, Frederic III., King of Sicily, 

1 See remarks on the subject of amulets, etc., on pages 197, 198. 



294 GROWTH OF MEDICINE 

for Ms broad-minded views regarding religious matters, 
and was both hated and feared by his enemies. According 
to trustworthy chronicles, Arnold of Villanova died at sea 
in 1311, within sight of the coast of Genoa, while he was on 
a voyage (probably from Sicily) to visit the Court of 
Clement V. In 1316 the Inquisition pronounced most of 
his philosophical and theological writings heretical, and 
ordered them to be destroyed. 

A complete collection of the medical writings of Arnold 
of Villanova, so far at least as they were then known to 
exist, was printed at Lyons, France, in 1586. It is said 
that many of the treatises which this author wrote have 
been lost. Of those which have come down to our time 
there are only three which call for any special comment — 
Arnold's ^^Breviarium," a compendium of the practice of 
medicine; his ^^ Commentary on the Regimen Salernita- 
num, ' ' the sales of which, according to Neuburger, reached 
an enormous figure ; and a work which bears the title 
^^Paraholae medicationis secundum instinctum veritatis 
aeternae, quae dicuntur a medicis regulae generates cura- 
tionis morhorum.''^ (Basel, 1560.) The latter treatise, 
which might with propriety be given the simple title of 
** General Rules regarding the Treatment of Diseases," is 
dedicated (1300 A. D.) to Philippe le Bel, King of France. 
It contains a number of chapters on the principles of 
general pathology, and others on special pathology and 
therapeutics, \vith relation both to internal diseases and 
to those which particularly interest the surgeon. It also 
furnishes 345 aphorisms, many of which embody truths 
of the highest importance and reveal the author to have 
been a man of independent judgment, of wide experience, 
and of a philosophical type of mind. 

In the '^Parabolae" and the '^Breviarium/* says Neu- 
burger, are to be found the most marked evidences of the 
knowledge and ability which this great physician possessed. 
He then adds : — 

Arnold attached much importance to hygiene and the proper 
regulation of the diet as effective measures in preventing diseases, 
and he formulated an admirable set of rules for the ordering of 



ADVANCE OF SURGERY 295 

one 's manner of living. In these he gives prominence to the value 
of baths, to the importance of taking a certain amount of physical 
exercise, and to the selection of the right kinds of food. He also 
describes in detail how wine may be utilized advantageously in 
cases of illness. As regards the choice of remedies to be employed 
he says that the physician should be guided by a very careful 
consideration of the patient's age, temperament, habits of living, 
etc. ; and, so long as there remains any doubt about the correctness 
of the diagnosis, he should employ only mild and indifferent 
remedies. The greatest care, he adds, should be exercised in the 
preparation of the drugs that are to be administered, and one 
should be very cautious about prescribing substances which have 
not been sufficiently tried. 

Arnold's writings are full of precepts which, like those 
quoted above, show him to have been an excellent practi- 
tioner of medicine as well as a man of sound common sense. 
And yet at the same time he appears to have been more or 
less tainted with the prevailing belief in astrology, in the 
efficacy of amulets (as in the case of Pope Boniface referred 
to on a previous page), "etc. His enemies gave him the 
reputation of being a sorcerer upon whom the Devil had 
bestowed the power of transmuting metals, — a reputation 
which undoubtedly was based upon the fact that Arnold 
interested himself greatly in alchemistic processes, often 
referring to them as closely resembling such organic 
phenomena as generation, birth, growth, etc. But, in our 
judgment of the man, we should be careful to remember that 
during the thirteenth century a belief in alchemy, astrology, 
the efficacy of amulets, the influence of supernatural 
agencies, etc., was almost universal. Even theologians 
maintained that it was a sin for a practitioner of medicine 
to neglect the influence of certain constellations. Indeed, 
there are even to-day, not a few very sensible people in 
whose minds exists a lingering belief in the interference of 
supernatural agencies in human affairs. 

The importance of the influence which Arnold of Villa- 
nova exerted upon the progress of medical science, and 
more especially upon the fame of the Medical School of 
Montpellier, should not be estimated exclusively from the 



296 GROWTH OF MEDICINE 

value of his writings nor from the character of the work 
which he performed as an instructor in that school. In the 
thirteenth and fourteenth centuries physicians as a class 
did not hold so high a position socially in Western Europe 
as they were probably entitled to hold, and consequently 
Arnold's later career, in which he showed himself to be a 
wise, broad-minded, and very able statesman and as an 
enthusiastic champion of greater liberty of thought in the 
domain of religion, must be looked upon as having aided 
very materially in raising the profession of medicine 
to a higher rank and in adding eclat to the School of 
Montpellier. 

Contemporaries and Successors of Arnold of Villanova 
at Montpellier. — During Arnold's lifetime there does not 
appear to have been another physician at Montpellier who 
could be compared with him in professional ability or in 
general culture. There was one, however, who attained 
considerable fame as a medical author, and who certainly 
deserves at least a brief notice in this place — Bernard de 
Gourdon, also known as Gordonius. 

Bernard de Gourdon^ began teaching medicine in Mont- 
pellier in 1285 A. D. He was the author of a treatise which 
bore the title "LiZiwm Medicinae/' and which enjoyed an 
unusual degree of popularity for a long period of time. 
The earliest printed edition appeared in Lyons in 1474 and 
was followed by several others in 1491, 1550, 1559 and 1574. 
One of the latest editions is that of Frankfort, 1617. The 
book was also translated into both French and Spanish. 
In his description of the seven parts into which the book 
is divided, the author says, by way of praising his own 
work: ''In the lily there are many different kinds of 
blossoms and in each one of these there are seven grains 
of a golden character." The book treats of fevers, poison- 
ings, abscesses, tumors, wounds and ulcers, of diseases of 
the liver, spleen, kidneys and bladder, of affections of the 
eyes, and of numerous other topics. The work as a whole, 

2 A small town in the Department of Lot, France. The earliest Norman 
ancestors of the Gurdon family in England are said to have derived their 
name from that of this town. 



ADVANCE OF SURGERY 297 

says Neuburger, lacks depth and thoroughness, and reveals 
the author to be overfond of employing drugs, especially 
in combination, and by no means free from a belief in the 
efficacy of amulets and other supernatural remedies. It 
contains, however, one or two references to matters of 
historical interest. For example, in Chapter V., Part III., 
mention is made of spectacles. So far as now appears, this 
is the first time that these useful contrivances are referred 
to in medical literature; and the casual manner in which 
the author speaks of them suggests the idea that they had 
already been known for some time. Possibly Roger Bacon, 
who interested himself in researches in the department of 
optics and who was a contemporary of Gordonius, may 
have had something to do with the invention of spectacles. 
At the ceremony of the marriage of the Duchess Juta 
of Austria to Count Louis of Oettingen, at Vienna in 1319, 
Pietro Buonaparte, the Podesta of Padua, created consid- 
erable excitement by wearing a pair of spectacles which he 
had received a short time previously from Salvino degli 
Armati of Florence, the reputed inventor of these con- 
trivances. It is not generally known that the printing of 
books in very large and bold type during the latter part 
of the fifteenth and the early part of the sixteenth centuries 
was done expressly for the benefit of far-sighted readers — 
this defect in vision characterizing a very large percentage 
of the learned men of that period. The great number of 
books which, during those early days of the art of printing, 
were published in this style, emphasizes the fact that the 
usefulness of spectacles was not generally appreciated 
until after the lapse of many scores of years. Being very 
expensive they were within the reach of only persons of 
wealth, and, in addition, they were extremely difficult to 
obtain. As late as during the year 1572, Augustus, Elector 
of Saxony, moved by a strong wish to possess a pair of 
spectacles, despatched a special messenger first to Leipzig 
and then to Augsburg with instructions to purchase them 
for him at the great annual fair. This agent, however, was 
unsuccessful in the attempt, and, accordingly, in the 
summer of 1574, he was instructed to ride on as far as 



298 GROWTH OF MEDICINE 

Venice. But, on arriving there, lie was informed that no 
glasses would be ground before the month of October. He 
was consequently obliged to remain in that city until the 
autumn, at which time he sent word to his master that the 
optician's charge for the instrument would be 50 thalers 
(equivalent to $250 at the present value of money). The 
Elector, it appears, was only too glad to pay this sum for 
the coveted article. The first spectacles made were 
equipped with only convex glasses, for the use of far- 
sighted persons. It was not until about two hundred years 
later that the art of grinding concave glasses for the relief 
of short-sighted individuals was discovered. 

Guy de Chauliac. — After the lapse of a few years there 
appeared a man who was destined to add greatly to the 
fame of the Medical School of Montpellier — not in the way 
in which Arnold of Villanova had accomplished this result, 
but by the publication of the first systematic treatise on 
surgery which was written in Western Europe during the 
Middle Ages. This man was Guy de Chauliac, about whose 
early life very little is known. He was born in the village 
of Chauliac, in Auvergne, France, toward the end of the 
thirteenth century, his parents being simple peasants ; and 
during early boyhood he probably attended the school 
connected with the village church. His medical studies 
were begun at Toulouse and completed at Montpellier. 
But, at some time later than 1326, he went to Bologna and 
perfected his knowledge of anatomy under the guidance 
of Bertrucius, Mondino 's successor. After leaving Bologna 
Guy visited Paris, arriving there subsequently to the 
deaths of Lanfranchi, Pitard and Henri de Mondeville. 
Although he remained in that great city only a short time, 
he appears to have formed a warm friendship with several 
of the instructors in the medical school. 

About the year 1330 he took up his residence in Lyons. 
His appointment to the position of Canon of Saint-Just, 
a church which is located in that city, doubtless made it 
necessary for him to adopt this course. And yet it is most 
improbable that he spent much of his time in Lyons, for 
his other duties — ^his attendance at the Papal Court in 



ADVANCE OF SURGERY 299 

Avignon, as private physician to three Popes in succession, 
and the numerous calls made upon him for professional 
advice and especially for surgical assistance by people 
living at a long distance from Lyons — compelled him 
repeatedly to absent himself from his home, sometimes for 
several days at a time. In 1348 the plague visited Avignon 
and carried off large numbers of people, the poet Petrarch's 
Laura being one of the victims. During that terrible 
epidemic Guy was most faithful in his devotion to Clement 
VI. and to many others who needed his professional ser- 
vices. In 1357 he was promoted by Innocent VI. to the 
office of Provost of Saint- Just. In 1363 when — according 
to his own declaration — he was an old man, he wrote the 
treatise on surgery which has rendered his name famous 
in the history of medicine. His death occurred about 
July 23, 1368. 

Guy was not, as some writers have asserted, a professor 
of surgery in the University of Montpellier ; he was simply 
a physician who had won at that institution the title of 
** Master in Medicine" — the highest grade conferred by 
the university authorities, and one which necessarily 
implied that the recipient had given a certain number of 
public readings on medical topics. And yet in actual 
practice Guy manifested a strong preference for the man- 
agement of diseases which demanded surgical treatment. 
His writings, furthermore, make it clear that he had a 
strong affection for the institution in which he had been 
both a student and in some measure an instructor. 

The book which Guy de Chauliac wrote, and which bears 
the title ^^La Grande Chirurgie," is described by Mal- 
gaigne,^ one of the most distinguished French surgeons of 
the nineteenth century, in the following terms: **I do not 
hesitate to say that, with the single exception of the book 
written by Hippocrates, there is not a work on surgery, no 
matter in what language written, which ranks higher than, 
or is even equal to, the magnificent treatise of Guy de 
Chauliac." Although most surgeons of the present day 
will scarcely assent to praise of such an extravagant 

8 Introduction to the "Oeuvres d'Ambroise Parg," Paris, 1840, 



300 GROWTH OF MEDICINE 

nature, they will undoubtedly agree in according to this 
admirable author of the fourteenth century a high place 
of honor in the Temple of Fame. Nicaise, the editor of 
the most recent version of Guy de Chauliac's treatise, 
speaks of him as the * ' founder of didactic surgery. ' ' From 
1363 A. D., the date of its first publication in manuscript, 
to 1478, a period of more than one hundred years, Guy's 
book was universally regarded as the authoritative treatise 
on surgery. But this branch of medicine, it must not be 
forgotten, was, at that period of the Middle Ages, held in 
very small esteem by physicians generally, and therefore 
it is almost certain that Guy received no encouragement 
whatever from any outside source. All the greater credit, 
therefore, is due him for the admirable manner in which 
he carried on the task which he had set before himself 
during the last years of his life. Extraordinary as it 
appears to us to-day, the Montpellier School of Medicine, 
toward the end of the fifteenth century (that is, only a 
comparatively short time after Guy's death), issued a 
decree that thereafter their pupils were not to study nor 
to practice surgery. From this and other well-authenticated 
facts it appears that the prejudice which existed at that 
period among physicians against surgery, was strong 
enough to render them blind to the reality that it was 
through the instrumentality of this very branch of medical 
activity that the school at Montpellier had gained such an 
increase in celebrity. They were unable to dispossess their 
minds of the idea that operative and all other surgical 
procedures were derogatory to the dignity of the educated 
physician. 

Guy de Chauliac wrote his treatise originally in Latin — 
not the Latin of the classical authors, but a Latin greatly 
deformed by the introduction of French, Arabic and 
Provencal terms — ^barbaric Latin, as it is often called. 
This language was commonly employed at the University 
of Montpellier and at all other universities at that period ; 
but, as Nicaise states, the style of his writing is so concise, 
and at the same time so intelligible, that it would scarcely 
be possible to translate it into modern French without the 



ADVANCE OF SURGERY 301 

loss of much of that which constitutes the charm of the 
book. It was for the latter reason that he decided to write 
his version of Guy's treatise in old French — the French 
of the thirteenth and fourteenth centuries. In order that 
our readers, most of whom are doubtless more or less 
familiar with the finished language of modern French 
literature, may see for themselves to what extent the latter 
differs from its fourteenth century ancestor, I shall intro- 
duce here a single paragraph of Nicaise's text. I have 
chosen it, more or less at random, from the admirable 
chapter which Guy has written on wounds in general. 

Consequemment playes mortelles non necessairement, ains pour 
la pluspart, sont petites playes, et superficielles es susdites parties, 
et qui penetrent iusques a icelles et aux chefs des muscles. La 
raison est, parce que si elles ne sont bien traitees, il advient qu'on 
en meurt : et si sont bien traitees, on en guerit : ainsi que i 'ay veu 
de la partie posterieure du cerveau, de laquelle sortit un peu de 
la substance du cerveau, ce qui fut reconnu par I'offense de la 
memoire, laquelle il recouvra apres la curation. le ne dis pas 
toutesfois qu'on vesquit, s'il en sortoit toute une cellule, comme 
Theodore raconte d'un cellier. Aussi Galen ne dit pas, de deux 
blessez qu'il vit guerir en Smyrne du vivant de son maistre Pelope, 
qu'il en fust sorty de la substance de cerveau, ains seulement que 
le cerveau avoit este blesse: Ne, de celuy qu'il vist guery en 
Smyme (comme il recite au huitiesme de V Usage), il ne dit pas 
qu'il en sortit de la substance du cerveau, ains qu'il fust blesse en 
I'un des ventricules gemeaux. Et avec ce on pensoit qu'il fust 
guery par le vouloir de Dieu. Car si tous deux eussent este blessez, 
il n 'eust gueres dure, comme il dit : et de ce il conclud 1 'utilite de 
la duplication de quelques instruments, ainsi qu'a este dit cy 
dessus en 1 'anatomic. Et tant de cettui-cy, que de ceux-la, la 
guerison rare est fort rarement faite, comme il est dit au com- 
mentaire dessus allegue. 

There are many places in Guy's treatise where his 
description of a surgical condition, or of the proper meas- 
ures to adopt for the relief or cure of such condition, would 
doubtless prove interesting to our readers, and would in 
any event aid them materially in forming an independent 
judgment as to the man's character in general and also 



302 GROWTH OF MEDICINE 

with regard to his qualifications as a surgeon. But all of 
these descriptions, when rendered in their entirety into 
English, occupy much space, and for this reason I shall 
be obliged to furnish here merely a few extracts from some 
of the more interesting portions of the text. 

In the chapter which Guy devotes to wounds of nerves, 
cords and ligaments — all of which structures were classed 
by him, as well as by Galen, as belonging to the category 
of nerves — this author divides them into punctured and 
incised wounds, bruises and concussions. As to the first 
variety he says that they may be divided into closed 
punctured and open punctured wounds. 

In the incised wounds two kinds may be distinguished : those in 
which the nerve is incised in the direction of its length and those 
in which the cut is made across the fibres. A further subdivision 
is practicable, viz., into wounds accompanied by more or less 
destruction of the substance of the nerve or its envelopes, and those 
in which such loss has not occurred. Among other differences 
worthy of mention are these: pain, spasmodic phenomena, and 
abscess formation are present in certain cases and absent in others. 
From all of which symptoms useful indications as to the treatment 
needed may be deduced. 

In the section relating to the treatment of such traumatic 
affections of nerves, Guy makes the remark that the meas- 
ures called for are, for the most part, the same as those 
required for wounds involving simply the fleshy parts of 
the body. 

The element of pain, however, is one of the factors which dis- 
tinguish wounds of a nerve from ordinary flesh wounds, and it 
may necessitate some slight modification of the treatment. Aside 
from this, one of the first things that should be done is to remove 
from the wound all foreign substances; after which the edges of 
the cavity should be brought together and held firmly in this 
position by appropriate means. Last of all, care should be taken 
to protect the parts. These are the general principles which are 
to guide the surgeon's action. As to the special details, they must 
depend upon the different conditions presented by each individual 
case. Thus, for example, if we are dealing vdth a punctured wound 
of a nerve, there will be no edges of an excavation to bring together. 



ADVANCE OF SURGERY 303 

If the object which produced the puncture is still lodged in the 
tissues, it must, as a matter of course,- be withdrawn. After which, 
the further measures to be adopted may be enumerated under the 
following heads: careful regulation of the manner of living; 
removal from the system of all material which — attracted to the 
wounded part by the pain — might there cause irritation or inflam- 
mation; and protection of the body against any harm that might 
come to it through the occurrence of convulsions. These three 
measures are indicated for all wounds of nerves. But, in the case 
of a punctured wound, still other procedures should be employed, 
as will be discussed under a fourth head. 

The four heads mentioned by Guy may be briefly stated 
in the following terms : I. The patient should be put upon 
a light and very simple diet ; and, in addition, he should be 
given a bed that is soft and humid {"humidus et mollis^ ^). 
His surroundings should be kept quiet, and nothing should 
be permitted to disturb his peace. of mind. 11. To protect 
his tissues from the injurious influence of any superfluous 
matters of an irritating nature that may be circulating in 
the blood {i.e., cacochyme), a vein on the opposite side of 
the body should be opened and a certain amount of this 
fluid withdrawn. In certain cases, furthermore, it may be 
well, in addition, to administer an aperient remedy. III. If 
convulsions develop, the head, neck and the entire back 
should be anointed with well-warmed linseed oil or common 
(? olive) oil, as recommended by Galen. IV. Special 
measures should be adopted for providing a free outlet for 
any pus that may form in the deeper parts of the wound ; 
and here again Galen recommends for this purpose the 
-employment of one of several medicinal preparations which 
he enumerates. ''But the more certain course," Guy adds, 
*'is to make an opening in the skin either with the razor or 
with the actual cautery (which latter, according to Henri 
de Mondeville, is the better plan of the two), and then to 
apply some subtle drying remedy which possesses the power 
to penetrate into the deepest recesses of the injured 
nerve — for example, savin oil." (Guy has a good deal 
more to say on the subject of wounds of nerves, but the 
few extracts given above should suffice. ) 



304 GROWTH OF MEDICINE 

It is now a well-known fact that Guy de Chauliac was in 
the habit of treating fractures of the thigh by the employ- 
ment of the weight and pulley as means of keeping up a 
continuing extension of the damaged limb. As his descrip- 
tion of the method in question is very brief, it may not seem 
out of place to reproduce it here. Translated into English 
it reads as follows : — 

As to the plan which I employ, it is this : After making fast to 
the fractured thigh splints which extend down as far as the feet, 
I reinforce the support which they give, either by placing the limb 
in a box or by applying to its sides bundles of straw (appuye- 
ments). [These are shown in the left-hand lower comer of Fig. 
12.] I then attach to the foot a mass of lead as a weight, taking 
care to pass the cord which supports the lead over a small pulley 
in such a manner that it shall pull upon the leg in a longitudinal 
direction. And if it then be found that there is not complete 
equality between the fractured limb and its fellow as regards 
length, the discrepancy may be corrected by gently pulling upon 
the former. Every nine days the limb should be cautiously 
handled; and at the end of about fifty days it will be found that 
firm union has taken place. 

One more remark seems to be called for in reference to the 
fact that Guy de Chauliac, although he was avowedly a 
surgeon, managed to win as great a reputation and as high 
a social position as was possessed by any physician of that 
period. The medical practitioner, it will be remembered, 
held himself, during the Middle Ages, and was universally 
held, to be a much higher type of man than the surgeon. 
The relative standing of the two is well shown in the 
accompanying sketch (Fig. 13), in which all the details 
(attitude, head gear, gown, etc.) have evidently been care- 
fully studied by the artist. Guy, however, through the 
sheer force of his character, and also probably because he 
was known to have won the highest medical honor (the 
grade of ** Master of Medicine") w^hich it was in the power 
of the university to confer, pushed his way to the top, and 
held, for a period of twenty years, the position of private 
physician to three Popes in succession — Clement VI., 
Innocent VI. and Urban V. In other words, the prevailing 




f patlion gractsi i famltes Isone^ tt octro^tspau 

tuuerenoptce eti oteuitbttfctgutaclamnefaut pcTtcfartfK ocSourses/rj^tttuitJiDS 
ttaiiM aujcbtmffaiffeats&clhofhl Wftttit^itrtStpontlftttttntmft? ausmcMOoniw 
irans ocuutcs m rtjacfu tiiu continnrutmeiu }> font t)cattte« rt ar ompKes e « pertbtmt 



litres membtfg at ^t tUcmit . 



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FIG. 12. ONE OF THE WAI^DS IN THE HOTEL-DIEU OF PARIS, 

As it appeared in the sixteenth century. 

(From Chirurgie de Pierre Franco, edited by E. Nicaise, Paris, 1895.) 



ADVANCE OF SURGERY 305 

prejudices and jealousies were not sufficiently powerful to 
block the triumphant career of this man of solid merit and 
high character. 

The State of Medicine and Surgery in Countries Other 
than Italy and France During the Later Portion of the 
Middle Ages. — From the account given by Neuburger it 
appears that the seeds planted by the famous teachers of 
medicine and surgery in Italy and France during the thir- 
teenth and fourteenth centuries had begun to take root in 
England and in the Low Countries to the north of France, 
and were in fact already producing some good fruit in those 
lands. Thus, for example, there have been handed down 
to our time the names of four physicians who attained a 
certain degree of eminence in England during the thirteenth 
and fourteenth centuries — Gilbertus Anglicus, John of 
Gaddesden, John Mirfeld and John Arderne. 

Gilbertus Anglicus, who was the first English medical 
writer to secure a certain degree of celebrity among the 
physicians of continental Europe, wrote a compendium of 
medicine that was commonly called the ^^Laurea anglica.*' 
The book contains, along with some good original observa- 
tions and the records of his own experience, not a few 
wearisome theoretical discussions; and at the same time 
it reveals the fact that the author was inclined to favor 
remedial measures of a superstitious nature. In the last 
chapter of his compendium, however, he makes the very 
practical suggestion that distillation may be resorted to 
when one desires to purify water that is contaminated. 
Gilbertus, after obtaining his preliminary training in Eng- 
land in the early part of the thirteenth century, visited 
some of the leading schools on the continent, among others 
those of Salerno and Montpellier, in which latter city he 
appears to have practiced medicine for a certain length 
of time. 

John of Gaddesden, who is also spoken of as Johannes 
Anglicus, was born about 1280 A. D. and died in 1361. He 
was therefore a contemporary of Guy de Chauliac. He is 
said to have been a Fellow of Merton College, Oxford, and 
to have held the positions of Prebendary of St. Paul's, 



306 GROWTH OF MEDICINE 

London, and of private physician to the royal family. He 
was also the author of a medical treatise which was gener- 
ally known by the title, '^Rosa Anglica^^ (first printed in 
1492). Neuburger speaks of this book as being an imitation 
of Gourdon's ^^Lilium Medicinae,^^ but of a somewhat 
inferior grade, and he quotes two or three passages which 
show that medicine was in a very low stage of development 
in England at the beginning of the fourteenth century. 
Gaddesden, for example, advises his confreres to adopt the 
rule of always securing their honorarium before they 
undertake the treatment of a sick person. In another part 
of the book he states that he treated one of the sons of 
Edward II. for small-pox and secured excellent results, 
not merely as regards the perfect restoration of his health, 
but also as regards the complete prevention of any pitting 
of his face. He attributes this success to the fact that he 
enveloped the patient in a red cloth and took pains to have 
every object in the vicinity of the bed draped in red.* 

John Mirfeld, who lived during the second half of the 
fourteenth century, completed his medical studies in 
Oxford, then entered the Monastery of St. Bartholomew's 
in London, and devoted himself thenceforward to work in 
connection with the hospital belonging to that institution. 
Among the books which he wrote there are a few that deal 
with matters of interest to the physician. Such, for 
example, are a glossary which bears the title ^^Synonyma 
Bartholomaei/' a work called the ^*Breviarium Bartholo- 

* ' ' Gaddesden had for a long time been troubled how to cure stone : ' At 
last/ says he, in his Bosa Anglica, 'I thought of collecting a good quantity 
of those beetles which in summer are found in the dung of oxen, also of the 
crickets which sing in the fields. I cut off the heads and the wings of the 
crickets and put them with the beetles and common oil into a pot; I covered 
it and left it afterwards for a day and night in a bread oven. I drew out 
the pot and heated it at a moderate fire, I pounded the whole and rubbed the 
sick parts ; in three days the pain had disappeared ; ' under the influence of 
the beetles and the crickets the stone was broken into bits. It was almost 
always thus, by a sudden illumination, that this doctor discovered his most 
efficacious remedies: Madame Trote [Trotula] of Salerno never confided to 
her agents in various parts of the world the secret of more marvelous and 
unexpected recipes." (From Jusserand's "English Wayfaring Life in the 
Middle Ages.") 



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ADVANCE OF SURGERY 307 

maei/' and a shorter treatise on prognosis — the ^^ Specu- 
lum.''^ None of these, however, possesses any special 
importance. 

John Arderne was born in England 1307 A. D., probably 
obtained his medical training in Montpellier, accompanied 
the English Army to France in the character of a 
* ' Sergeant-Surgion, " and was present at the battle of 
Crecy (1346 A. D.). During the succeeding twenty-four 
years he practiced medicine in Wiltshire and Newark, and 
then settled for the remainder of his life in London. 
Although his practice included both internal diseases and 
those which required surgical treatment, the great reputa- 
tion which he acquired was based chiefly upon his success 
in the latter field. Most of his writings, it appears, are 
still in the form of manuscript. . They deal chiefly with 
surgery and are accompanied by drawings of the instru- 
ments which he employed. They possess one feature 
which distinguishes them from the majority of medical 
writings of the Middle Ages, viz., they abound in reports 
of cases observed and treated by the author ; and, further- 
more, the methods of treatment which he recommends are 
in most instances rational and of a relatively simple nature. 
The only one of Arderne 's treatises which has been printed 
is that relating to fistula in ano. . It bears the title, *' John 
Arderne — Treatises of Fistula in Ano, Haemorrhoids, and 
Clysters ; from an early fifteenth-century manuscript trans- 
lation," and is edited by D'Arcy Power, Early English 
Text Society, Original Series, 139; London and Oxford, 
1910. Arderne, we are told by Neuburger, puts forward 
two claims : 1, that he succeeded in curing a large number 
of cases of anal fistula, in proof of which he gives the names 
of the persons upon whom he operated successfully, many 
of whom are high up in the social scale ; and, 2, that no other 
surgeon of whom he has any knowledge, either in England 
or on the continent of Europe, is able to cure the disease. 

The three English physicians of whom I have here given 
very brief accounts, can scarcely be said to compare 
favorably with those men who, during the same period, 
brought fame to the medical schools of Bologna, Padua, 



308 GROWTH OF MEDICINE 

Montpellier and Paris ; and this fact suggests the question, 
Do these men really represent the best type of physicians 
who lived in England during the fourteenth century? The 
great English poet Chaucer, in his ''Canterbury Tales" 
(written at about the same period of time), furnishes us 
with a portrait of a man who appears to have been well 
informed with regard to the earlier Greek and Arabian 
medical authorities as well as with the leading physicians 
of his own time, and who in addition was clever both in 
ascertaining the causes and nature of his patients ' maladies 
and in prescribing for them the proper remedies. As this 
physician's name is not mentioned, we cannot be sure that 
he was not one of the three to whom reference has just been 
made. By the description given by the poet, who probably 
was personally acquainted with the man whose portrait 
he draws, one is tempted to believe that he was a physician 
of a higher type than any one of the three named above. 
Chaucer 's account reads as follow : — 

There was also a Doctor of Phisik, 

In al this worlde was ther non him like 

To speke of phisik and of surgerye ; . 

For he was grounded in astronomye. 

He kepte his pacient wondrously and we 

In all houres by his magik natural. 

Well coude he gesse the ascending of the star 

Wherein his patientes fortunes settled were. 

He knew the cause of every maladye, 

Were it of cold, or hete, or moyst, or drye, 

And where they engendered, and of what humour ; 

He was a very parfit practisour. 

The cause once knowen and his right mesure, 

Anon he gaf the syke man his cure. 

Ful redy hadde he his apothecaries. 

To sende him drugges, and electuaries, 

For eche of them made the other for to wynne ; 

Their friendshipe was not newe to begynne. 

Wei knew he the old Esculapius, 

And Discorides, and eek Rufus ; 

Old Ypocras, Haly and Galien ; 

Serapyon, Razis, and Avycen ; 



ADVANCE OF SURGERY 309 

Averrois, Damascen, and Constantyn ; 

Bernard, and Gatisden, and Gilbertyn. 

Of his diete mesurable was he. 

For it was of no superfluitee, 

But of gret norishing and digestible. 

With the names of the three English physicians men- 
tioned above, there should be associated that of Jehan 
Yperman, who was born in Ypern, Flanders, during the 
latter half of the thirteenth century, obtained his profes- 
sional training in Paris under Lanfranchi, and then, in 
1303 or 1304, accepted the position of Physician to the 
Hospital of Belle, a small Flemish town. In 1318 he settled 
permanently in Ypern, his native city, and in a compara- 
tively short time won completely the confidence and esteem 
of his fellow townsmen through his attentiveness to their 
wants when they were ill and through the great skill which 
he manifested in his work as a surgeon. He died 1329 A. D. 

Yperman 's writings deal with both medical and surgical 
topics. Of those which have been translated from the Latin 
into French are: **La chirurgie de maitre J. Yperman," 
Anvers, 1863; **Traite de medecine pratique de maitre 
J. YpeTman," Anvers, 1863; and **Traite de medecine 
pratique de maitre J. Yperman," Anvers, 1867. A perusal 
of these works, says Neuburger, easily convinces one that 
Yperman was not only a skilful and clever surgeon, 
but also a physician of independent judgment and wide 
experience. 

Revival of the Practice of Dissecting Human Bodies. — 
It was in Italy that dissecting was carried on during the 
fourteenth century more vigorously than elsewhere in 
Europe. At first the only persons who made such investi- 
gations for scientific purposes were individual physicians 
or groups of physicians; and, in addition, they were 
obliged to carry on the work in a secret manner — that is, 
by stealing from recently dug graves the corpses which 
were necessary for such studies. It is related, for example, 
that in 1319 one of the teachers in the Medical School at 
Bologna and four of his pupils were brought before the 
Court of Law under the charge of having clandestinely 



310 GROWTH OF MEDICINE 

disinterred, for purposes of dissection, the body of a man 
who had been hung for some crime. At first the authorities 
merely winked at such transgressions, but at the same time 
they made no attempts to have the law against dissecting 
annulled or at least modified. Then, at a somewhat later 
period, the conviction became general among the intelligent 
members of the community that, unless work of this nature 
were officially sanctioned, no real advance in the knowledge 
of human anatomy could be made, and — what was probably 
of even greater importance in their estimation — that 
Bologna might at the same time lose a good deal of its 
superiority over its rivals as a centre of learning; and 
accordingly it was found practicable to grant the desired 
sanction with many modifying restrictions attached. Then, 
with the further lapse of time, other medical schools fell 
into line and secured from the authorities similar privileges 
for their teachers and pupils. Thus, in 1368, the Senate 
of Venice authorized the medical school of that city to make 
a public dissection of a human body once every year; and, 
eight years later, the University of Montpellier acquired 
the same privilege. In 1391 John I. of Spain was equally 
generous in his treatment of the Medical School at Lerida. 
After the opening of the fifteenth century no further 
difficulties of a serious nature were experienced by the 
teachers of anatomy in procuring at least some material 
for dissecting purposes, and with each succeeding year such 
facilities steadily increased. Unfortunately, however, there 
did not follow a corresponding increase in the knowledge 
of human anatomy. As a matter of fact, it was not until 
during the sixteenth century that any really valuable work 
was accomplished in this branch of medicine. Guy de 
Chauliac, in the first chapter of his treatise {^^La Grande 
Chirurgie^^), gives the following description of the manner 
in which Bertrucius taught anatomy in Bologna at the 
beginning of the fourteenth century, and from this account 
it is easy to understand why the additions to our stock of 
information in this department of medicine were so few and 
so unimportant during this long period. The so-called 
dissecting, it clearly appears, was in reality a not very 



ADVANCE OF SURGERY 311 

profitable combination of purely anatomical work of a 
primitive character and a search for evidences of patho- 
logical changes. The clinical history of the individual 
whose body was undergoing examination does not seem to 
have played any part in the investigation. Here is 
De Chauliac's account: — 

After placing the dead body on a bench, my master proceeded 
with his instructions, devoting thereto four separate sittings. 
At the first of these he passed in review those parts or organs 
which are concerned in nutrition; his reason for considering them 
first being that they are the earliest to undergo decomposition. 
At the second sitting he devoted himself to the spiritual organs 
of the body; at the third, to the animal parts; and at the fourth, 
to the extremities. Following the example furnished by Galen in 
his commentary on the book entitled "The Sects," he maintained 
that there were nine things which should be taken into considera- 
tion when one examines the different parts of the body, to wit: 
their situation ; their nature, color, bulk, number, and shape ; their 
connections or relations; their actions and their utility; and the 
diseases which may affect them. Conducted in this manner the 
study of anatomy, he maintained, may prove helpful to the physi- 
cian in recognizing diseases, in making prognoses, and in selecting 
a suitable plan for treatment. 

Puschmann, quoting from Hyrtl, says that Avhen Pro- 
fessor Galeazzo di Santa Sofia, who had been called from 
Padua to Vienna to fill the Chair of Anatomy in the 
medical school of that city, made his first public dissection 
of a human body (1404 A. D.) in the Biirgerspital, the 
sittings covered a period of eight days ; at the end of which 
time he collected as much money as he could from those 
who had attended the course, and turned it over to the 
treasurer of the Faculty. Then followed a period of twelve 
years during which not a single public dissection of a 
human body was made in Vienna. In 1440 the Faculty were 
greatly rejoiced over the prospect of receiving from the 
authorities the body of a criminal who was to be hung on 
a certain day ; but, when the time arrived and the body had 
actually been delivered to them, they were grievously 
disappointed by the sudden coming to life of the supposed 



312 GROWTH OF MEDICINE 

corpse. Instead of dissecting him for the benefit of science, 
the doctors bestirred themselves in the man's behalf, 
obtained a pardon in due form, and sent him back to his 
home in Bavaria under the escort of the college janitor. 
Not very long afterward, however, he committed a fresh 
crime, and this time was effectively hung. History does 
not state whether the dissection then came off, or not. 

The Medical Faculty of the University of Tiibingen 
established the rule in 1497 that one human body should 
be publicly dissected every three or four years; it being 
understood that during the progress of the dissection the 
professor should read aloud to the class appropriate 
portions of Mondino's treatise on anatomy. The instruc- 
tion in this department of medical science was of the same 
general character in all the other universities of Germany 
at that period. Anatomical drawings, of a very crude type, 
were employed as substitutes for actual dissection. 

At Padua, in Northern Italy, the science of medicine had 
already before the end of the first half of the fifteenth 
century made a decided advance, in proof of which several 
circumstances may be mentioned. In the first place, the 
importance of the study of anatomy had by this time 
become so generally recognized that no special difficulty 
appears to have been encountered in securing the erection, 
in 1446, of an anatomical theatre; and during this same 
period several physicians connected with the medical 
school acquired considerable celebrity by their publication 
of important treatises on topics belonging to the domain 
of general pathology and therapeutics, and by the wide 
influence which they exerted as teachers. Among the 
number of those who helped in these ways to spread the 
fame of the Medical School of Padua may be mentioned 
Hugo Benzi, Antonio Cermisone, Giovanni Savonarola and 
Bartolommeo Montagnana. 

Hugo Benzi (or Hugo of Siena) taught philosophy as 
well as medicine in different institutions of learning — at 
Pavia, Piacenza, Florence, Bologna, Parma, Padua and 
Perugia. His death probably occurred at Ferrara about 
the year 1439. In addition to commentaries on Hippocrates, 



ADVANCE OF SURGERY 313 

Galen and Avicenna, he wrote several practical works 
{^^Consilia'^) on such topics as periodical insanity, sto- 
machic vertigo, naso-pharyngeal polypi, epilepsy, lachrymal 
fistula, etc. 

Antonio Cermisone was a native of Padua, became a 
teacher of medicine first in Pavia and afterward in Padua, 
wrote several useful treatises about various diseases, and 
finally died about 1441. 

Giovanni Michele Savonarola — the grandfather of the 
celebrated Girolamo Savonarola, who was burned at the 
stake for heresy 1498 A. D. — held the Chair of Medicine 
in Padua from about 1390 to 1462, and also subsequently 
for a certain length of time in Ferrara. He was the author 
of a number of treatises on practical medical topics — such, 
for example, as fevers (first published in Venice in 1498), 
the art of preparing simple and compound aqua vitae 
(Basel, 1597), an introduction to the practice of medicine 
(1553), the baths of Italy and of the rest of the world 
(Venice, 1592), the different kinds of pulse, etc. (Venice, 
1497) — and he also wrote a large work covering the entire 
field of medicine and modeled on the pattern of Avicenna 's 
*' Canon." The book is divided into six parts, each of 
which is preceded by an introduction that is devoted to the 
anatomico-physiological bearings of that particular part; 
and here, in addition, there are to be found scattered 
throughout the text references to surgical procedures. 
Among the references of this character the following 
deserve to be mentioned as worthy of some notice: the 
description of a speculum for use in operations upon the 
interior of the nose; a reference to direct laryngoscopy; 
the description of an instrument closely resembling the 
well-known syringotome ; the treatment of curvature of the 
spine by mechanical means, etc. The book also reveals the 
fact that, already at this period of the history of medicine 
(the middle of the fifteenth century), physicians were 
beginning to take a more active part than they had pre- 
viously done in the management of confinement cases, 
which as a rule were left entirely to the care of midwives. 
The records also show that medical men were interesting 



314 GROWTH OF MEDICINE 

themselves more and more, as time went on, in sanitary- 
science as applied to municipal affairs. In most commu- 
nities the need for such was indeed most urgent at that 
time. The reforms of this nature were pushed -with special 
vigor in those parts of Italy which were governed by that 
enlightened ruler of the Hohenstaufen family, Frederic II., 
King of Sicily and Roman Emperor. The cultivation of 
personal hygiene was also pursued very systematically 
during the later Middle Ages, the Regimen Salernitanum 
serving as the guide in such matters. 

Taken all together the conditions in the physician's 
world were in anything but a promising state toward the 
end of the fifteenth century ; but the dawn of better times, 
of modern medicine, was near at hand, and already signs 
of its approach were beginning to be recognizable in 
different parts of Western Europe. 



CHAPTER XXV 

BRIEF HISTORY OF THE ALLIED SCIENCES- 
PHARMACY, CHEMISTRY AND BALNEOTHER- 
APEUTICS 

During the excavations carried on at the site of Pompeii, 
there were discovered three houses which bore every 
appearance of having been occupied by apothecaries. 
Among the objects found in these buildings were : A bronze 
box equipped with the apparatus required for mixing 
ointments; a few surgical instruments; several glass 
receptables which had evidently at some earlier period 
contained fluid or semi-fluid pharmaceutical preparations, 
but which, at the time when the excavations were made, 
presented merely a deposit of some solid but easily friable 
substance at the bottom of the vessel ; and quite a variety 
of drugs in the form of pills, tablets, powders, etc. At first, 
the impression prevailed that these must have been the 
houses of apothecaries, but subsequently the discovery, in 
each instance, of the house sign representing a snake with 
a pine cone in its mouth (the symbol of Aesculapius) 
satisfied the authorities that these particular buildings 
had belonged to physicians. Indeed, as a matter of fact, 
no good reasons have thus far been found for believing 
that apothecaries, in the modern acceptation of the term, 
existed in even the largest cities of Greece and Italy until 
a much later date. 

Pharmacy in Its Infancy. — All through the Hippocratic 
period and during the years when Alexandria was at the 
height of its prosperity as the great centre of medical 
activity, it was customary for the physicians to prepare 
their own drugs. The same is true of the best physicians 



316 GROWTH OF MEDICINE 

belonging to the Augustan period; they were not willing 
to put their trust in the drugs which had been prepared in 
the shops where such things were usually sold. 

In the second century of the present era Galen gave the 
definition that a remedial drug, or ' * Pharmakon, " was 
something which, when taken into the living body, produces 
an alteration in its component tissues or organs, whereas 
foods or nutrient elements simply cause an increase of the 
parts. He attached great importance to such character- 
istics as purity, freshness, care in handling, etc. It was 
his custom to prepare with his own hands the different 
combinations of simple remedial agents which he admin- 
istered to his patients, and he kept these combinations, as 
well as the simple drugs of the more costly kinds, carefully 
stored in locked wooden boxes in a room which was 
devoted to this special purpose and which was termed the 
* * Apotheke. ' ' Originally, therefore, the ' * apothecary ' ' was 
simply the person who had charge of this room in which 
the drugs and spices were carefully ** placed to one side" 
(dTTo, rldr}^) for safc keeping. At a later period, when the 
caretaker became also the compounder of drugs, another 
word of a more comprehensive significance — that of 
''pharmacist" — gradually supplanted the term apothecary. 

There is another word, ''antidote," which has very 
materially changed its significance during the lapse of 
centuries. Galen, for example, employed this word as a 
synonym of pharmakon — a simple remedial agent, and 
medical writers continued using the term in this sense 
during the following thirteen or fourteen centuries. The 
word commonly employed, by mediaeval physicians, to 
signify "pharmacopoeia," was " antidotarium. " In 
modern times the word "antidote" signifies only an agent 
which neutralizes a poison. 

Galen took a very great interest in everything relating 
to the subject of drugs, and sometimes made long journeys 
for the purpose of securing certain plants or roots which 
he was unable to procure near home or which he was very 
anxious to obtain in a more perfect condition than was 
possible when they were purchased from the regular deal- 



HISTORY OF THE ALLIED SCIENCES 317 

ers. ** Simple remedies," he declared, **are pure and 
unadulterated, and produce effects in only one direction. 
It is the business of pharmacology to combine drugs in 
such a manner — according to their elementary qualities of 
heat, cold, moistness and dryness — as shall render them 
effective in combating or overcoming the conditions which 
exist in the different diseases. ' ' Galen 's interest in pharma- 
cology materially aided the advance of medical science in 
other ways. He systematized the existing knowledge of 
materia medica and infused some measure of orderliness 
into the therapeutics of his day. The success of his efforts 
in this direction did not become manifest until after he had 
been dead about fifty years ; but, if his ideas were slow in 
meeting with general acceptance, they took such deep root 
in the minds of physicians that to-day in Persia Galen's 
system of therapeutics is the only one generally received 
as authoritative. Although the facts do not warrant our 
making the same statement with regard to Western and 
Southern Europe, it is nevertheless true that our dispen- 
satories still continue to honor the memory of this great 
physician by bestowing the name of ** Galenical Prepara- 
tions" on a large group of pharmaceutical combinations. 
It is scarcely possible to state with any degree of posi- 
tiveness at what date pharmacists, in the modern sense 
of the term, came to be recognized as constituting a 
separate and honorable class in every well-organized 
community. It is known, however, that in Syria and Persia, 
during the eighth and ninth centuries of the present era, 
not a few of the leading physicians were the sons of 
apothecaries. Honein, for example, of whose career I 
furnished a brief sketch in Chapter XIX., was the son of 
an apothecary; and the careful manner in which he was 
educated during his youth justifies the belief that his father 
must have been a man of some cultivation and not at all like 
the general average of that class of men of w^hom Galen 
speaks so disparagingly. But even at that early period 
there certainly were individuals who were skilled in the 
pharmaceutic art, for Berendes {op. cit.) tells us that 
Dioscorides {circa 100 A. D.) describes minutely the 



318 GROWTH OF MEDICINE 

manner of preparing ^'Oisypum." Oisypnm is identical 
with the modern ' * Lanolin " or ' ' Lanolinum, ' ' and is a pure 
fat of wool. Mention is made of the preparation by four 
different authors of medical treatises during the following 
sixteen centuries — ^viz., by Aetius in the sixth, by Paulus 
Aegineta in the seventh, by Nicolaus Myrepsus in the 
thirteenth, and by Valerius Cordus in the seventeenth. 
Subsequently to the latter date no further mention of the 
preparation is to be found in any of the pharmacopoeias 
except the French Codex of the year 1758, in which it is 
classed among the simple remedies under the title of 
''Oesipe." Finally Liebreich, toward the end of the nine- 
teenth century, brought the preparation once more into 
favor under the name of ''lanolin." The fact that it 
remained in complete oblivion for such very long periods 
of time is easily explained by the statement which Berendes 
makes: *'It was a troublesome ointment to manufacture, 
and consequently the apothecaries disliked it and resorted 
to all sorts of falsifications. ' ' 

With the advance of the Arab Renaissance pharmacy 
gradually became a regular established occupation in every 
fairly large city in the East. It is known, for example, 
that the first public apothecary shop in the city of Bagdad 
was established during the eighth century of the present 
era under the caliphate of Almansur; and about the same 
time, probably a little earlier, there existed at Djondisabour 
a similar pharmacy in connection with the school and 
hospital of the Bakhtichou family. The training of an 
apothecary in those days was probably the same as that 
of the physician. Originally pharmacists were called 
' ' Szandalani, " probably because they dealt largely in 
sandal wood. 

The materia medica furnished by the Arab physician 
Rhazes in the different works which he has written, is 
unusually rich in simple elements, the majority of which 
are always drugs of a rather mild action; Greece, Persia, 
Syria, East India and Egypt were the sources from which 
they were derived. Beside the simple elements, Rhazes 
mentions a number of composite preparations of drugs. 



HISTORY OF TEE ALLIED SCIENCES 319 

As not a few of the latter required very careful manipu- 
lation, it may safely be inferred that the Arabian 
apothecaries of the ninth century had already acquired 
considerable skill and experience in their special field of 
work. 

At Salerno, during the first half of the twelfth century, 
pharmacy began to assume a position of considerable 
importance. The work which was- prepared by Nicolaus 
Praepositus, and which was known as an ' * Antidotarium, " 
furnished quite full information with regard to the char- 
acters and therapeutic uses of nearly 150 different drugs. 
According to Berendes this work served for several cen- 
turies as the basis of later pharmacopoeias. One of its 
notable features is the importance which the author attaches 
to the duty of weighing very carefully each of the drugs 
that enter into the composition of a given preparation, of 
gathering certain vegetable products at the right season, 
and of paying strict attention to their quality and to the 
manner of preserving them. 

In 1140 A. D., Roger, King of Naples and Sicily, pro- 
mulgated a law which defined what should be the proper 
relations between physicians and apothecaries; and about 
one hundred years later (1241 A. D.) Frederick II. 
amplified and gave greater precision to this law, thus 
establishing what was practically an Institute of Apothe- 
caries. The following provisions constitute the essential 
features of the law : — 

1. The physician and the apothecary shall have no business 
interests in common. 

2. The physician shall not himself conduct an apothecary shop. 

3. In each department of the kingdom two respectable men, 
selected by the Faculty at Salerno, shall be assigned the duty of 
furnishing sworn statements to the effect that all the electuaries, 
syrups, and other preparations of drugs kept for sale in a given 
apothecary shop, have been made according to the established 
prescriptions and are offered for sale only in that state. 

4. In the case of those preparations which ordinarily do not 
keep for a longer time than one year without spoiling, the price 
at which they are to be sold shall be at the rate of 3 Tarreni (about 



320 GROWTH OF MEDICINE 

30 cents) per ounce; while those which ordinarily remain un- 
changed during a longer period, shall be valued at 6 Tarreni per 
ounce. 

At the time which we are now considering, it was not the 
custom, owing largely to the expensiveness of writing 
paper, to deliver to the pharmacist a written prescription. 
Instead, the physician first gave his instructions in person, 
and then, after he had seen the mixing and other steps of 
the apothecary's work properly performed, he carried the 
preparation to the patient's house. 

Long before the middle of the fifteenth century apothe- 
caries had become thoroughly well established throughout 
Central and "Western Europe. Among the statutes of the 
Medical Faculty of Erfurt, Germany, there has been found 
one which dates back to the year 1412 and which says : — 

The student of medicine, before he applies for the Bachelor's 
Degree, should spend one month in the spring of the year, in an 
apothecary's establishment, in order that he may familiarize him- 
self with the proper manner of preparing clysters, suppositories, 
pessaries, syrups, electuaries and other things necessary for a 
physician to know. 

The first work which was really worthy of being termed 
a treatise on materia medica was published in 1447. It 
bore the title, "Compendium Aromatariorum, " and was 
written by Saladin of Ascolo, the private physician of 
Prince Antonio de Balza Ossino of Tarentum. Berendes 
says that it was a work of much practical value. 

The First Indications of the Beginning of Chemistry. — 
Up to a comparatively recent date it has been customary 
to speak of Geber as the first practical chemist and the first 
writer among the ancients who appreciated the important 
part which chemistry was likely to take in medicine and 
philosophy at no distant period of time. But to-day, as 
appears from the researches made by M. Berthelot about 
1893, we are compelled to abandon the belief that such a 
person as Geber existed, and shall have to adopt the more 
commonplace view that the science of chemistry represents 
a gradual development from the much older alchemy. We 



HISTORY OF THE ALLIED SCIENCES 321 

may define the latter branch of knowledge as the science 
of transforming copper and brass into gold and silver. 
During the first two or three centuries of the Christian era 
there existed a firm belief that such a transformation had 
actually been accomplished, and in confirmation of the 
correctness of this statement it may be said that Zosimos 
of Panopolis, one of the leading philosophers of Alexandria 
during the fourth century of the present era, and a man 
who was considered by his contemporaries, as well as by 
all later alchemists, to be perhaps the greatest authority 
in this branch of knowledge, speaks in unmistakable terms 
in his cyclopaedic work on alchemy (28 volumes), of a 
certain tincture which possesses the power of changing 
silver into gold, and also of a ** divine water" or fluid which 
is capable of effecting many different transmutations. 
There can therefore be no reasonable doubt that in the 
earlier centuries of the Middle Ages the learned men of 
Alexandria accepted alchemy as a well-established agency 
of great power. From the sixth century to the thirteenth 
this science was cultivated with great assiduity by the 
Arabs in the academies which they established in Cordova 
and other cities of Spain ; and it was from the latter region 
that the belief in alchemy spread to all the countries of 
Western Europe, gradually gaining strength up to perhaps 
the fifteenth century. 

It was during the thirteenth century that the so-called 
'* philosophers' stone" came to be considered the most 
effective agent in transmuting the baser metals into silver 
and gold, and there were not a few who even believed that 
this as yet non-existent stone possessed the power to in- 
crease longevity, to confer health, and to give a prosperous 
issue to one 's undertakings. It was not the rabble, but the 
very best and most highly educated men in the community 
who, during the thirteenth century, took the most active 
interest in alchemy and the philosophers' stone. Arnold 
of Villanova, Raymund Lullus, Roger Bacon, Albertus 
Magnus, and, to a lesser degree, the famous theologian 
Thomas Aquinas were all believers in the art of the magir 
cian. And even more extraordinary than this is the fact 



322 GROWTH OF MEDICINE 

that in Germany men of this stamp continued for two or 
three centuries longer to cherish a belief in the reality of 
alchemistic processes. Even Martin Luther (1483-1546), 
the great reformer, did not hesitate to express his approval 
of '^the black art," as is shown by the following quotation 
from one of his writings: — 

The art of alchemy is commendable and belongs in truth to the 
philosophy of the ancient wise men, a fact which pleases me greatly, 
not merely because of the intrinsic merits and usefulness of the 
art in the matter of distillations of vegetables and oily fluids and 
sublimation of metals, but also because it serves as such a noble 
and beautiful symbol of the resurrection of the dead at the last 
day of judgment. (Berendes.) 

Another celebrated character who dabbled in the black 
art was Johannes Faust, who was born in 1485, obtained 
his degree of Bachelor of Arts at the University of Heidel- 
berg, and died in 1540 in Staufen in Breisgau. Professor 
Scherer of Berlin says that *'he was a great braggart, 
never failed to create a sensation wherever he went, and 
had the conceit and effrontery to pass himself off as a 
scientist among the learned men of his day. He called 
himself the philosopher of philosophers, a second Magus. 
He maintained that he was both a physician and an 
astrologer, and claimed that he could restore the dead to 
life, and could predict future events from a mere inspection 
of fire, air and water." 

But although the persistent and wonderfully energetic 
activities of the alchemists failed to find the philosophers* 
stone, or to transmute the baser metals into silver and gold, 
they placed in the hands of man the key to a knowledge 
of chemistry, that branch of science which was destined 
in later years to play such an important part in pharmacy, 
in agriculture and in other industries. Thus we owe to 
alchemists the discovery of many processes and the inven- 
tion of many apparatus which serve as the groundwork 
of modern chemistry. Some of the more important of 
these are the following: The use of the spirit lamp; the 
invention of tubular retorts ; the production of potash and 



HISTORY OF TEE ALLIED SCIENCES 323 

soda by burning the hard deposit which collects in wine 
casks as well as various marine plants; the oxidizing of 
certain metals (iron, lead, copper, quicksilver and anti- 
mony) ; the making of metallic arsenic, of wine of anti- 
mony, of sulphate of iron, of chloride of silver, of acetic 
acid and of many other chemical products ; the purification 
of metals by the use of lead, etc. 

Supplementary Data Relating to Balneotherapeutics. — I 
have referred to this subject on several occasions in the 
course of the earlier chapters of this history, but always 
without entering very much into details. This policy was 
adopted, partly because the facts upon which a satisfactory 
sketch of the growth of balneotherapeutics might be based 
were not very numerous, and partly because of the neces- 
sity of gaining space for more important matters. 

The principal facts to which I made reference were: 
First, that before the Christian era the employment of 
baths in a variety of different ways for therapeutic pur- 
poses was universal in the East; and, second, that in the 
city of Rome during the centuries immediately following 
the birth of Christ, facilities for this kind of treatment 
were provided on a most lavish scale — as in the baths of 
Agrippa (27 A. D.), of Titus (79 A. D.), of Caracalla 
(211 A. D.), and of Diocletian (302 A. D.). I may now add 
that the warm springs of Aachen (Aix-la-Chapelle), Baden- 
Baden and Wiesbaden, in Central Europe, and Bath, in 
England, were known to the ancient Romans, and were 
utilized by them to some extent for therapeutic purposes ; 
but it was not until a much later period that they and the 
less well-known springs of Schwalbach, Driburg, Warm- 
brunn, Goeppingen and Gastein began to be actively 
frequented for remedial purposes. By the beginning of 
the sixteenth century it had become a very popular thing 
for sufferers from all sorts of ailments to resort to these 
and other European springs. The history of the thera- 
peutic employment of mineral waters belongs, however, to 
the period of modern medicine rather than to that which 
I have been considering in the present volume. 



PART III 
MEDICINE DURING THE RENAISSANCE 



CHAPTER XXVI 

IMPORTANT EVENTS THAT PRECEDED THE 
RENAISSANCE— EARLY ATTEMPTS TO DIS- 
SECT THE HUMAN BODY 

Important Events Immediately Preceding the Renais- 
sance. — Three hundred years before the Christian era 
Erasistratus and Herophilus made, at Alexandria, Egypt, 
an attempt to develop a correct knowledge of anatomy by 
means of dissections of human corpses, but the political 
and religious conditions at that time were not favorable 
to scientific work, and therefore the success attained was 
of a very restricted character. Then, during the succeeding 
three or four centuries, this early movement gradually died 
out, and no further contributions to our knowledge of 
human anatomy were made until toward the end of the 
second century of the present era, at which time Claudius 
Galen, a man of giant intellect and tireless energy, did his 
best to supply the anatomical knowledge so urgently 
needed. But the deeply rooted prejudices of that age 
against dissections of the human body lay like an insur- 
mountable barrier across his path and forced him to confine 
his efforts to the dissection of those animals whose bodily 
construction resembled more or less closely that of man. 
Galen believed that the anatomy which he thus evolved 
for the guidance of his professional brethren would satisfy 
all their legitimate wants of this nature, and he proceeded 
to build upon this faulty and unstable foundation an equally 
faulty physiology. History records the extraordinary fact 
that Galen's belief in the sufficiency of his anatomy and 
physiology for all the reasonable needs of physicians and 
surgeons was so well grounded that during the following 



328 GROWTH OF MEDICINE 

thirteen or fourteen centuries nobody dared to cast the 
slightest suspicion upon the trustworthiness of these 
foundations of the science of medicine. Then followed, 
during the fourteenth and fifteenth centuries, an awakening 
which seemed to affect all departments of human activity. 
This movement, which is commonly termed the ''Renais- 
sance, ' ' developed at first very slowly, and reached a note- 
worthy degree of momentum only toward the middle of the 
fifteenth century, about which time there occurred several 
events that contributed greatly to strengthen and per- 
petuate the movement. Such were, for example, the 
employment of gunpowder in the wars of Western Europe ; 
the invention of a method of manufacturing paper — a 
discovery which led to the abandonment of the much more 
expensive parchment, and prepared the way for the 
invention of printing in its different forms; the taking 
of Constantinople by the Turks in 1453; the discovery of 
America in 1492 ; and, finally, the Reformation inaugurated 
by Martin Luther. Let us pass in review very briefly each 
of these events, in order that we may the better appreciate 
how the science of medicine, in the short space of time 
represented by a couple of centuries, made a greater 
advance than it had previously made in the course of 
several hundred years. 

The employment of gunpowder in warfare robbed the 
knight of the protection which he had previously enjoyed 
from the wearing of metal armor, and thenceforward his 
life was as much imperiled in battle as was that of the foot- 
soldier, who was not permitted to protect his person in this 
manner. Thus were the two upper classes of the commu- 
nity, the nobles and the bourgeois, in any conflict which 
might arise between them, placed more nearly upon a 
footing of equality. The ultimate result showed itself in 
an increased importance, an increased prosperity, of the 
middle class or bourgeoisie, from which the physicians 
chiefly came. Indeed, feudalism from this time forward 
rapidly ceased to exist. 

The discovery of paper, an excellent and relatively cheap 
substitute for parchment, facilitated wonderfully the spread 



EVENTS PRECEDING THE RENAISSANCE 329 

of knowledge. Parchment, the material upon which books 
were written, was expensive and was at times difficult to 
obtain; both of which circumstances rendered books so 
costly that only a few physicians were able to become the 
owners of the important standard medical works of that 
period — such, for example, as the Hippocratic writings, 
Galen's treatises, the surgical manuals of de Mondeville 
and Guy de Chauliac, the pharmacopoeia of Dioscorides, 
and still other books of lesser value. And, if a satisfactory 
method of manufacturing paper had not first been dis- 
covered, the benefits growing out of the invention of 
printing in 1467 would have been far less than they actually 
proved to be. Some idea of the magnitude of these benefits 
may be formed from the following statement of facts. The 
demand for books, after the invention of printing, became 
so great that the presses were kept almost constantly busy. 
At first, according to the record furnished by Haeser, 
Venice and Rome took the lead in supplying this great 
demand for books; the former city printing 2978 and the 
latter 972 volumes between the years 1467 and 1560; but, 
during a later period (1500-1536), Paris outstripped Venice 
with a total of 3056 volumes, and Strassburg advanced to 
the second place with a showing of 1021 volumes printed 
during the same period of time. Thanks to the great 
diminution in the market price of books that resulted from 
the two inventions named — the manufacture of paper and 
the introduction of printing — almost every physician in 
fairly prosperous circumstances was able at that period 
to purchase the relatively few medical treatises which 
issued from the presses; and, besides, new authors were 
thenceforth stimulated to put their experiences into print. 
Among the very first medical books printed the following 
deserve to be mentioned: — 

(In Germany.) Buck der Biindth-Erznei, by Heinrich von 
Volsprundt, 1460. — Das huch der wund Artzeny. Handwirckung 
der Cirurgia von Jyeronimo hrunschwick, 1508. — Das Feldtbuch 
der Wundtartzney, by Hans von Gerssdorff, 1517. 

(In Italy.) Avicennae opera, arabice, 1473. — Guillelmi de 
Saliceto cyrurgia, 1475. (A French translation was published at 



330 GROWTH OF MEDICINE 

Lyons in 1492.) — Celsi de medicina liber, etc., 1478. — Guidonis de 
Cauliaco cyrurgia, 1490. (A French version was printed in Lyons 
in 1498.) 

(In France.) Christophori de Barzizus de fehrihum cognitione 
et cura, 1^94:.— Bernard de Gourdon, traduction de son "Lilium 
medicinae," 1495. 

When Constantinople fell into the hands of the Turks 
in 1453, many of its Greek inhabitants, and particularly 
those belonging to the more highly educated classes, fled 
to Western Europe in order to escape from the tyranny 
of the invaders. Not a few of these refugees brought with 
them to Italy and France copies of the works of the classical 
Greek authors, and on this account, as well as because of 
their willingness to give instruction in their native tongue, 
they met with a cordial welcome wherever they took up 
their new abodes. Their arrival in Italy happened at a 
most propitious time, for the interest in Greek literature 
was at that period just beginning to develop among Italian 
scholars. Previously, Greek had been an almost unknown 
tongue in Italy. Petrarch, for example, is reported to 
have said in 1360 that he did not know of ten educated men 
in that country who understood Greek; and there is no 
evidence to show that the number of such men increased 
between 1360 and the time when the refugees from Constan- 
tinople arrived. Many of the works of greatest importance 
to physicians — such, for example, as the writings of 
Hippocrates, of Galen, of Rufus of Ephesus, of Oribasius, 
of Alexander of Tralles, and of several other classical 
medical authors of antiquity — were accessible (in the 
original) only to those who were familiar with the Greek 
tongue. Consequently the arrival of these refugees from 
Constantinople constituted a most important event in the 
history of European medicine. 

The discovery of America by Christopher Columbus in 
1492 owed its origin in part to the restless spirit of 
adventure which was abroad in Spain and Italy at that 
time, and also, in perhaps still larger measure, to the hope 
of gain which might be expected to follow the discovery of 
a shorter and more direct route to India. As regards the 



EVENTS PRECEDING THE RENAISSANCE 331 

attainment of the latter object, the great explorer failed, 
but his discovery of a new continent resulted eventually in 
bringing great wealth to the rulers of Spain, in stimulating 
maritime commerce, and in broadening men's views with 
regard to every phase of human activity. The addition 
of a few new drugs to the pharmacopoeia was a further 
result of some importance. Luther's efforts to reform the 
government and doctrines of the Church undoubtedly gave 
a great impetus to the Renaissance and therefore to the 
growth of the science of medicine. Men learned to use 
their reasoning powers with greater freedom, and as a 
result our knowledge of the structure of the human body 
(anatomy) and of the working of its complicated machin- 
ery, both in health (physiology) and in disease (pathology), 
made astounding advances. And it is to the consideration 
of these fundamental branches of medical knowledge that 
we must now turn our attention. 

Early Attempts to Dissect the Human Body. — Already 
as early as during the first half of the fourteenth century 
physicians began to appreciate the fact that further 
progress in the knowledge of medicine was not to be 
attained otherwise than by a more profound study of human 
anatomy than had been made up to that time; and they 
realized that it was only by means of actual dissections that 
this more profound study might be made. Various in- 
fluences, however, co-operated to hinder such study. In 
the first place, the people at large were thoroughly imbued 
with the idea that dissecting a human corpse was an act of 
desecration, and consequently it was by no means safe for 
a physician to do any work of this character except in the 
most secret manner. Then, in addition, it was commonly 
believed — and this belief persisted even up to a compara- 
tively recent date — that the bull which Pope Boniface VIII. 
issued in 1300 — and which declared that whoever dared to 
cut up a human body or to boil it, would fall under the ban 
of the church — ^was intended to cover dissections for pur- 
poses of anatomical study. The recent investigations of 
Corradi, however, show (Haeser, p. 736 of the third 
edition) that this bull was not intended to apply to dissec- 



332 GROWTH OF MEDICINE 

tions for scientific purposes, but simply to put an end to 
the practice of cutting up human corpses and boiling the 
separate sections in order to obtain the bony framework 
in a condition suitable for transportation from Palestine 
to Europe, — a practice which had grown to be very common 
among the Crusaders. 

Mondinus' ''Anatomy," which was published in 1314, 
reveals the fact that, during the early part of the fourteenth 
century, several private dissections were made. As might 
be expected, from the primitive character of the illustrations 
that accompany the text of Mondinus' work, these dis- 
sections were carried out in a very imperfect manner, for — 
to mention only a single example — this author admits that 
he made no attempt to investigate the deeper structures 
of the ear, as such an examination would necessitate the 
employment of violent measures, ' ' which would be a sinful 
act." 

The archives of the Bolognese School of Medicine con- 
tain an item which reveals the active interest taken in 
anatomy by the students of that day. It reads as follows : 
''At Bologna, in 1319, several of the Masters stole from 
a grave the corpse of a woman who had been buried two 
days before, and then turned it over to Master Albertus 
to dissect in the presence of a large number of students." 
At the Medical School of Montpellier, in the south of 
France, the Faculty obtained permission in 1376 to dissect 
the corpse of an executed criminal once every year; and 
the records show that the school actually availed itself of 
this privilege in the years 1377, 1396 and 1446. Felix 
Platter, who afterward became one of the most distin- 
guished physicians of Basel, Switzerland, pursued his early 
medical studies at the latter university during the years 
1552-1557 ; and, in the diary which he faithfully kept during 
this period, he reveals in an interesting manner what 
difficulties as well as dangers he experienced, first, in 
reaching Montpellier from his home in the eastern part of 
Switzerland, and, second, in obtaining greater opportuni- 
ties for acquiring a genuine knowledge of anatomy than 
the school itself afforded in its official course. Although, 



EVENTS PRECEDING THE RENAISSANCE 333 

owing to lack of space, I shall not be able to quote in full 
the appropriate portions of this most interesting narrative, 
I will furnish an abridged English translation of the story 
as it appears in Platter's journal or diary. In all its more 
important details the account reads as follows ; — 

Our little party was composed of three persons, viz., Thomas 
Schoepfius, the schoolmaster of St. Pierre ; a Parisian by the name 
of Robert who happened to be passing then through Basel on his 
way to Geneva; and myself, a lad of sixteen. We traveled on 
horseback and all three of us were armed with rapiers. My outfit, 
which was handed to me by my father shortly before our departure, 
consisted of two extra shirts and a few pocket-handkerchiefs, 
wrapped up in a piece of waxed cloth. In the matter of funds for 
the journey I received from my father three crowns in silver and 
four gold pieces which, for further security, he sewed into my vest. 
In addition, he presented me with a rare piece of silver money 
which had been issued by the Cardinal Mathieu Schiner, of the 
Canton de Valais, who personally commanded the Swiss soldiers 
in their successful combat with the troops of Louis the Twelfth, at 
Marignan. It was a coin, therefore, which possessed considerable 
historical value. My mother also bestowed upon me a gold coin 
(a couronne). As a last injunction my father begged me not to 
forget that, in order to procure the money which he had just placed 
in my hands, as well as that which he had already paid for my 
horse, he had been obliged to mortgage his property. 

We left the city at nine o 'clock on the morning of Oct. 10th, 1552, 
and at the same moment the news reached us that the Plague had 
made its appearance in Basel. This was a most depressing piece 
of intelligence, especially as we were already in great fear that the 
army of the Emperor Charles the Fifth, which was at that time 
on its way to the siege of Metz, would utterly destroy our city. 

We arrived at Berne early on the morning of Oct. 12th, and, 
after leaving our horses at the inn, The Falcon, lost no time in 
visiting the objects of interest in that ancient city, not forgetting 
the bear pit, in which there were at that time six of these creatures. 
In the afternoon we resumed our journey toward Fribourg, and 
very soon overtook a newly married couple. As they were traveling 
on horseback like ourselves, and were following the same route 
for a certain distance, we all agreed to keep together. While 
passing along a shady part of the road the bride's dress became 
so firmly entangled in the branches of an apple tree that, failing 



334 GROWTH OF MEDICINE 

to stop the horse, she was left suspended in the air by her skirts. 
I immediately dismounted and helped her to regain her feet, to 
adjust her disordered dress, and to resume her seat in the saddle. 
On arriving at Fribourg we put up at the inn called La Croix 
Blanche, and soon discovered that almost everybody in the town 
spoke French, a language with which Thomas and I, who were 
Germans, were not familiar ; but, thanks to our companion Robert, 
the Parisian, we experienced no difficulty whatever in making all 
our wants known and in securing all the information that we 
desired. 

On the following day, Oct. 13th, it was raining hard when we 
left Fribourg, and we were soon wet to the skin. After passing 
through several small villages we stopped for refreshment at an 
inn in the picturesque town of Romont, and at the same time 
availed ourselves of the opportunity to have our clothes dried. 
Then, having satisfied our appetites, we resumed our journey in 
the direction of Lausanne ; but we did not get very far on our way 
before we discovered that Thomas had disappeared. "We were of 
course obliged to wait for him, and, by the time he had rejoined 
the party, darkness and a thick fog combined to render further 
progress very difficult, and we soon realized that we had lost our 
way. We wandered up and down for some time without encounter- 
ing a barn or building of any kind in which we might find shelter 
from the rain and secure a measure of protection from the robbers 
who, according to common report, infested that part of the 
country. Finally, however, we discovered a small village; but, 
when we applied for a night 's lodging, not one of the householders 
was willing to receive us. So we engaged the services of a young 
peasant to act as our guide, and with his assistance we finally 
reached a mean-looking inn in a village called Mezieres, which was 
composed of a few widely scattered houses. We entered the tavern 
and found several Savoyard peasants and some beggars seated at 
the long table of the bar-room; they were engaged in eating roasted 
chestnuts and black bread, which they washed down with copious 
draughts of a liquor called piquette. They unceremoniously 
examined our weapons and acted with great rudeness toward us 
in other respects. The woman who kept the house said she had no 
other room which she could place at our disposal, and our first 
impulse therefore was to resume our journey immediately after 
we had finished our meal of black bread and chestnuts; but, after 
careful reflection, we came to the conclusion that such a course 
might prove fraught with considerable danger. So we decided to 



EVENTS PRECEDING THE RENAISSANCE 335 

remain awake and watch for an opportunity to make our escape. 
Very soon afterward these half-intoxicated men lay down on the 
floor before the fire in the adjoining hall- way or vestibule and fell 
into a sound sleep. Our guide then confessed to us that, while at 
work in the stable, he had heard them planning to waylay us on 
the highway at an early hour of the following day. As soon, 
therefore, as, we heard them all snoring lustily we very quietly 
slipped out of the house. Our score having already been paid 
earlier in the evening, and our horses having been left saddled and 
bridled in the stable, we mounted and took our departure by a road 
which led at first in a direction different from that in which we 
were supposed to be traveling. We experienced no further trouble 
on this part of our journey and in due time reached Lausanne. 
When we told the people at the inn about our experience at 
Mezieres they replied that we might consider ourselves most fortu- 
nate, as almost every day there occurred, in the forest through 
which we had passed {la For it du Jorat), a murder or some other 
deed of violence.^ It was plain, therefore, that we had had a narrow 
escape from death. 

In the further course of our journey along the north shore of 
the lake we reached the city of Geneva on Oct. 15th. When I called 
upon John Calvin, to whom my father had given me a letter of 
introduction, he said to me: "My Felix, you arrive at the right 
moment, for I am now able to give you an excellent traveling 
companion for the remainder of your journey — to wit, Dr. Michel 
Heronard, a native of Montpellier. " This Dr. Heronard, as I 
learned subsequently, was a Protestant who played a prominent 
part in the religious disorders which, a few years later, greatly 
disturbed the peace of that city 

On the 30th of October — just twenty days after we set out from 
Basel — we entered the city of Montpellier, and I lost no time in 
hunting up Laurent Catalan, the apothecary, at whose house I 
expected to reside during my stay in that city. 

Platter had now, after a long and dangerous journey, 
reached one of the three greatest medical schools of that 

1 Some weeks later our fellow voyager, Thomas Schoepfius, wrote to me that, 
on the return journey, he learned at Berne that "Long Peter," the leader of 
the MeziSres robbers, had been apprehended by the authorities and executed 
for his crimes; and that, when stretched on the rack, he had confessed, among 
other things, that he had tried to murder and rob some students who passed 
through M6zi6res on their way to Lausanne. 



336 GROWTH OF MEDICINE 

period, and it was his hope and expectation that he would 
here be able to acquire a correct and intimate knowledge 
of human anatomy. He was already aware that this 
knowledge could be satisfactorily obtained in only one 
way — that is, by dissecting the human body; and accord- 
ingly he availed himself of every possible opportunity, 
during the five years which he spent at Montpellier, to 
accomplish this purpose. From the somewhat superficial 
examination which I have made of the record furnished 
by the diary, it appears that only five or six official lessons 
or demonstrations were given by the professor of anatomy 
during the period of time named; but — as every student 
of medicine knows — instruction of this character is of 
relatively small value; and Platter himself seems to have 
realized fully the truth of this statement, for during 
the second year of his stay at Montpellier he joined 
a secret band of nocturnal grave-robbers who were 
determined at all hazards to obtain the material needed for 
self-instruction. The following brief description of one 
of the raids made by this band of eager searchers after 
knowledge will convey a good idea of the manner in which 
the work was conducted : — 

Our first excursion of this kind was made on Dec. 11th, 1554. 
As soon as it was really dark our fellow student Gallotus guided 
us, along the road that leads to Nimes, to the Augustinian Monas- 
tery, which is situated about half-way between Castelnau and the 
Verdanson brook. Here we were received by a monk called 
Brother Bernard, a bold and determined fellow, who had disguised 
himself for the business in hand. At midnight, after we had par- 
taken of food and drink, we started out, sword in hand, for the 
cemetery which is located close to the church of Saint Denis. Here 
we dug up with our hands a corpse which had been interred that 
very day; and, having lifted it out of the pit by means of ropes, 
and wrapped our cloaks around it, we carried the body on two 
canes as far as Montpellier. Then, having concealed our load 
close to the postern, alongside the city gateway, we summoned the 
keeper and begged him to get us some wine, as we were dying of 
thirst and very tired. "While he was absent in search of the wine 
three of our party slipped in through the passage and carried the 
corpse safely to Gallotus' house, which was only a short distance 



EVENTS PRECEDING THE RENAISSANCE 337 

from the gate. The gate-keeper returned in due time with the 
wine, and did not appear to have the slightest suspicion of the trick 
that we had played upon him. It was now three o'clock in the 
morning. 

The control exercised by the authorities over the practice 
of dissecting human corpses differed very appreciably at 
different dates in different parts of Europe. Thus, for 
example, orders were issued to the Italian bishops during 
the latter part of the fourteenth century to put a stop to 
further dissections, and for a period of over one hundred 
years these orders accomplished the purpose desired. On 
the other hand, the Emperor Charles the Fourth adopted 
a more liberal course : from the year 1348 on he permitted 
dissections of human corpses to be made without hindrance 
in Prague, Bohemia, but his liberality in this particular 
appears to have been of little use, for there is no evidence 
to show that the knowledge of anatomy made any appre- 
ciable advance anywhere in Europe until after the begin- 
ning of the sixteenth century. 

Gabriel Zerbi of Verona (1468-1505) published at Venice 
in 1502 the first modern treatise on human anatomy that 
deserves to receive special mention. Pagel speaks of it 
as containing fairly good descriptions of different parts 
of the body. Zerbi held the Chair of Medicine, Logic and 
Philosophy in the University of Padua, and lectured first 
in that city, next at Bologna, and finally at Rome. One 
incident in his career may prove of interest to the reader 
as showing the fearful risks to which a practicing physician 
in those days was sometimes exposed. The incident was 
of this nature : — 

A wealthy pacha in Constantinople, failing to obtain relief from 
his malady at the hands of the native Turkish doctors, summoned 
an Italian physician from Venice. Zerbi, whom the ruling Doge 
invited to accept the summons, sailed immediately for Constanti- 
nople in company with his two sons who were mere lads. The 
treatment which he inaugurated proved promptly successful, and 
Zerbi, having been handsomely remunerated for his services, was 
already on his way back to Venice when his ship was overhauled by 
a swift-sailing caique on board of which were the sons of his recent 

/ 



338 GROWTH OF MEDICINE 

patient, who — as the story goes — had celebrated his recovery by 
eating and drinking to excess. This debauch promptly caused his 
death — probably by cerebral apoplexy ; but the sons were convinced 
that it was the result of poison administered by Zerbi, and accord- 
ingly they lost no time in starting out to capture the supposed 
murderer. Their first act, on reaching the vessel which they were 
pursuing, was to kill the younger of the two sons, in the presence 
of the father, by sawing his body in two lengthwise. Then they 
killed Zerbi himself in the same manner. 

Tiraboschi, the first historian of Italian literature (1731- 
1794), is mentioned by Dezeimeris as his authority for this 
terrible tale. The events here narrated occurred in 1505. 

At the beginning of the sixteenth century — the period 
with which our history now has to deal — ^the only available 
knowledge of anatomy was that which had been supplied 
by Galen in the third century of the Christian era, and 
which had been handed down through all the intervening 
centuries as something absolutely correct and not to be 
challenged. But the time had arrived when men were no 
longer willing to accept as truth the teachings of any 
individual until they had subjected them afresh to the most 
searching investigations; and thus it came about that a 
group of remarkably able men devoted all their energies, 
during the greater part of the sixteenth century, to a very 
critical study of human anatomy. As the work accom- 
plished by these men constitutes a very important chapter — 
perhaps the most important chapter — ^in the history of 
medicine, I may be pardoned if I devote a disproportion- 
ately large amount of space to the consideration of the 
careers of the more prominent of these founders of modern 
anatomy, and to an enumeration of the details of the work 
which they accomplished, and which furnished the most 
complete verification of the truth stated by Francis Bacon, 
Lord Verulam (1561-1626), in the following words (trans- 
lation) : — 

Man has no other means of getting at and revealing the truth 
than by induction coupled with a never-tiring, unprejudiced 
observation of nature and an imitation of her operations. Actual 



EVENTS PRECEDING THE RENAISSANCE 339 

facts must first be collected, and not created by a process of 
speculation. 

One of the earliest and most thorough students of human 
anatomy was Marc Antonio della Torre (1473-1506), who 
belonged to an honorable family of Verona, several mem- 
bers of which had attained distinction as physicians. He 
planned to publish a treatise on anatomy, and, with this 
object in view, secured the assistance of Leonardo da Vinci 
(1452-1515), the celebrated painter, architect and civil 
engineer, to make life-size pictures of the parts which he 
had dissected with such care. But, after the latter had 
completed many of the drawings which were intended to 
serve as illustrations for the projected treatise, Della Torre 
unexpectedly died, and the book was never finished. Quite 
a number of the drawings, however, found their way to 
England, and for many years past they have been carefully 
treasured at Windsor Castle and in certain private 
collections. If Delia Torre's life had been spared it is 
highly probable that his treatise on anatomy, equipped with 
illustrations copied from this great artist's dramngs, would 
have constituted a formidable rival of Vesalius' famous 
work. 

Not long after this event it became the rule, among the 
leading painters and sculptors of the Renaissance period, 
to pay a great deal of attention to the study of human 
anatomy. The museums of Central and Southern Italy 
contain quite a large number of anatomical drawings that 
were made by Michael Angelo, by Raphael and by other 
great masters of that period. Doubtless many of my 
readers recall seeing, in the Cathedral of Milan, Marco 
Agrate's (1562) extraordinary masterpiece, in the form 
of a life-size black marble statue which represents Saint 
Bartholomew standing erect, and carrying on one arm the 
folded skin of his entire body. In this statue all the muscles 
and bony prominences are modeled with perfect accuracy. 
It is a remarkable work of art. 



CHAPTER XXVII 

THE FOUNDERS OF HUMAN ANATOMY AND 
PHYSIOLOGY 

Among the earliest physicians of this period to inculcate 
the importance of substituting a correct knowledge of 
anatomy for the frequently incorrect descriptions that had 
been prepared by Galen and handed down through the 
succeeding centuries, were the following : Jacques DuBois 
of Paris (1478-1555), who was perhaps better known by 
his latinized name of "Sylvius"; Guido Guidi (died in 
1569), who was also known as "Vidus Vidius"; and 
Winther of Andernach, a small city on the Rhine. These 
three men, all of whom taught anatomy at Paris, were 
commonly considered the best anatomists of that early 
period. DuBois was further entitled to the credit of having 
been the first physician to inject blood-vessels with a 
material that renders them more easily visible, and also 
the first person in Paris to dissect a human corpse. It was 
from these men that Vesalius, who afterward became such 
a famous anatomist, received his first practical instruction 
in this branch of medical science. Nothing further need 
be said here of DuBois, but brief sketches of Guido Guidi 
and of Berengarius of Carpi, another contemporary 
anatomist of considerable distinction, deserve to find places 
in our history of this period. Vesalius' facetious remark 
that ''Winther of Andernach never used a knife except for 
the purpose of dissecting his food" absolves us from the 
duty of saying anything further about his career as an 
anatomist. 

In 1542 Francis the First, King of France, gave a great 
impulse to the study of medicine by calling Guido Guidi 
from Florence, Italy, to teach that science in the College 



HUMAN ANATOMY AND PHYSIOLOGY 341 

de France, an institution which he had founded at Paris 
in 1530. Guidi, upon his arrival in Paris, was at once most 
cordially received, both by those who were to be his col- 
leagues and by the King. Francis bestowed upon him a 
suitable gift, appointed him to the position of First 
Physician (Archiater) at his Court, and assured him that 
he would receive an ample salary during his residence in 
the French metropolis. In 1547, after the death of Francis 
the First, Guidi returned to his home in Florence, where 
Cosimo dei Medici, at that time the head of the Florentine 
Republic and a little later Grand Duke of Tuscany 
(Cosimo III.), made him his First Physician and gave him 
the appointment of Professor of Philosophy in the Univer- 
sity of Pisa. Not long afterward Guidi was transferred 
to the Chair of Medicine. He retained this position almost 
up to the time of his death (May 26, 1569), and during this 
long period Cosimo bestowed upon him various ecclesiastic 
honors, which not only increased his social rank but added 
materially to his financial resources. 

Dezeimeris says that, while Guidi does not deserve to 
be placed, as an anatomist, in the same rank with Vesalius 
and Fallopius,^ he merits full credit for the very important 
service which he rendered the physicians of his day by 
placing within their reach translations of certain Greek 
treatises relating to surgical topics — such treatises, for 
example, as those of Hippocrates on ulcers, on wounds of 
the head, on the joints and on fractures (with Galen's 
comments), Galen's treatise on fasciae, and that of Ori- 
basius on ligatures and other surgical contrivances. 

Apart from his merits as a worker in the field of medical 
science, Guidi occupies a creditable place in the history 
of medicine as a fine type of the well-educated and kindly 
disposed physician, as the following testimony given by 
Benvenuto Cellini, the distinguished Florentine sculptor, 
shows : — 

On the occasion of my visit to Paris I made the acquaintance of 
Messer Guidi, and I wish to state in what a very friendly manner 

1 Also often spelled ' * Falloppius. ' ' 



342 GROWTH OF MEDICINE 

I was received by that noble citizen of Florence and excellent 
physician, the most virtuous, the most lovable, and the most 
domestic man whom I have ever met. 

Guidi 's treatise on anatomy was first published at Venice 
(under the editorship of his nephew) in 1611 — i.e., forty- 
two years after his death. His translations from the Greek 
treatises of Hippocrates, Galen and Oribasius will be found 
in the work which bears the title ^^Collectio Chirurgica 
Parisina,'^ Paris, 1544. 

Berengarius of Carpi (a small town in Northern Italy), 
who died in 1530, is pronounced by Kurt Sprengel a worthy 
predecessor of Vesalius. He was Professor of Anatomy, 
first at Pavia and then at Bologna (from 1502 to 1527), and 
he is reported to have dissected more than one hundred ( !) 
cadavers during that period. Fallopius and Eustachius 
were among his pupils, and it was their opinion that he 
did more than anybody else to revive the interest in 
anatomical work. The famous sculptor, Benvenuto Cellini 
(1500-1571), is authority for the statement that Berengarius 
was not only an experienced anatomist and practicing 
physician, but also a very skilful draughtsman; the three 
works which he published being illustrated with a certain 
number of original woodcuts that are not without interest 
both to the anatomist and to the lover of art. 

Andreas Vesalius (1514-1564) was born at Brussels, of 
German parents whose home was located at Wessels on the 
Rhine, — ^whence the name ''Vesalius." His father was the 
apothecary of the Princess Margaretha, Charles the Fifth's 
aunt, and several of his ancestors had been physicians of 
considerable distinction. At Louvain he received, in early 
youth, a thorough training in the Latin, Greek and Arabic 
languages and also in mathematics. When he was about 
eighteen years of age, he visited Montpellier and afterward 
Paris, at which latter city he received practical instruction 
in anatomy from the three men whose names I have 
mentioned in the preceding paragraph — ^viz., Guido Guidi, 
Jacques DuBois and Winther of Andernach. The instruc- 
tion in anatomy given in Paris at that period (about 1533) 
consisted in interpretations of Galen's teachings, in dis- 



HUMAN ANATOMY AND PHYSIOLOGY 343 

sections of a few animals, and in occasional demonstra- 
tions — which never lasted longer than three days — of the 
easily accessible parts of a human cadaver. Scanty as were 
these sources of information, Vesalius cultivated them with 
the greatest zest. From time to time his teacher, DuBois, 
noting the interest which his pupil took in anatomy, and 
recognizing his fitness for imparting instruction, assigned 
to him the special duty of rehearsing, in the auditorium, 
before his fellow students, the essential facts of the day's 
lecture. After war had been declared between the Emperor 
Charles the Fifth and Francis the First, King of France, 
Vesalius left Paris and returned to Louvain, where he 
began lecturing on anatomy. These lectures constituted 
the very first attempt at anything like systematic instruc- 
tion in anatomy that is known to have been made at that 
ancient university. It was while he was engaged in this 
work that Vesalius, in order to become the possessor of an 
entire human skeleton, — a thing of which he felt a very 
great need, — ventured to remove from the gallows, outside 
the city, the cadaver of a criminal. This, as Haeser 
declares, was an act of great boldness and full of peril. 

The life of a military surgeon attached to the army of 
Charles the Fifth, which was the life that Vesalius led dur- 
ing the following year or two, was not sufficiently attractive 
to divert his mind seriously from his favorite study; and 
it is therefore not surprising that we find him, at the age 
of twenty-three, accepting from the Senate at Venice the 
appointment of the professorship of anatomy at the 
University of Padua. When he entered upon this new work 
Vesalius felt considerable uncertainty as to the correctness 
of the anatomy which he was then teaching, and it is there- 
fore easy to understand why his first three lectures were 
based entirely upon the teachings of Galen ; but, before he 
had finished the third one of the series, he made up his 
mind that he would cut loose from the anatomy of the ape 
and confine himself to that of the human subject, as was 
then being revealed to him more and more perfectly from 
his own dissections. The stock of knowledge which he had 
thus begun to accumulate, increased steadily until, after 



344 GROWTH OF MEDICINE 

seven years of teaching at Padua, Bologna and Pisa, at 
each of which schools of medicine he gave courses in 
anatomy of seven weeks' duration, and after conducting 
the most painstaking dissections of a number of human 
cadavers, he finally declared that he was ready to publish 
his great treatise on anatomy. Some of his friends, fore- 
seeing clearly what a storm of protest the new book would 
arouse among the followers of Galen, urged him to postpone 
for a time its publication; but a few others agreed with 
him that it should be issued without further delay. 
Accordingly Vesalius sent the manuscript of his work at 
once to the printers at Basel, and the book was finally 
published in June, 1543, before its author had attained his 
twenty-ninth year. Its title was ^^De corporis humani 
fabrica/' and it was provided with exceptionally fine pic- 
torial illustrations, most of which were drawn, as is gener- 
ally believed, by John de Calcar, one of Titian's pupils. 
A second edition, superior in every respect to the first, was 
published in 1555. In comparison with this great work 
the few treatises written by Vesalius in later years are of 
minor importance. 

Vesalius may rightly be considered the founder of modern 
anatomy, for he was the first to furnish correct information, 
based on actual dissections of the human cadaver, respect- 
ing quite a large number of the more important anatomical 
relations; and by this very act he won the further credit 
of having dealt the first effective blow toward the dethrone- 
ment of Galen, the man who, next to Hippocrates, — 
probably even more than Hippocrates, — had exercised, by 
his teachings in nearly every department of medical 
science, almost despotic sway over physicians for consider- 
ably more than one thousand years. At this distance of 
time, it is hard to realize what a startling effect was pro- 
duced by the announcement of the discovery of so many 
errors in Galen's scheme of anatomy. Albert von Haller, 
the great authority on medical literature, speaks of 
Vesalius' book as an "immortal work"; and, although its 
title would lead one to suppose that it deals only with the 
construction of the human body, an examination of its 



ff 




FIG. 14. ANDREAS VESALIUS. 

(After the portrait by Van Calcar in the Royal College of Surgeons, 
London.) 

Copied from the reproduction publi.shed in the Nederlandsch Tijdschrift 
voor Geneeskunde, Jan. 2, 1915. 



HUMAN ANATOMY AND PHYSIOLOGY 345 

contents reveals the fact that it contains in addition quite 
full information regarding physiology and pathological 
anatomy, as well as many details relating to comparative 
anatomy. Perhaps the most marvelous thing about this 
book is the fact that its author completed his work before 
he had reached his twenty-eighth year. It may also interest 
the reader to learn that, prior to 1914, the University of 
Louvain possessed a copy of Vesalius' great work printed 
on vellum and illustrated with many drawings in colors; 
but I am unable to say whether this beautiful volume did 
or did not escape destruction at the hands of the ruthless 
men who invaded Belgium during the summer of that 
memorable year. 

When the human mind has adjusted itself, in the course 
of years, to consider certain beliefs and ideas as settled 
truths, it comes as a painful shock to be told that these 
beliefs are erroneous and that new ones must take their 
places. This is precisely what happened when Vesalius' 
book was first published. From one end of Europe to the 
other there was a very great stir among the well-educated 
physicians ; the more liberal minded being ready to accept 
at once the genuineness of the new anatomy, whereas 
others, — and possibly they represented the larger num- 
ber, — acting under the influence of personal jealousy or 
perhaps blinded by the belief that it was impious not to 
accept without questioning the descriptions made by 
Galen, were scandalized by the boldness of Vesalius in 
asserting that many of the statements made by this great 
medical authority were incorrect. Jacques DuBois, whose 
name has been mentioned by me on a previous page, was one 
of the most bitter of Vesalius' assailants. In a pamphlet 
which he published in Paris in 1551 he even went so far as 
to speak of his late pupil as ' * a crazy fool who is poisoning 
the air of Europe with his vaporings." On account of 
their former pleasant relations, and also because DuBois 
was at that time an old man, Vesalius made no reply to 
these attacks; but when Bartholomaeus Eustachius, Pro- 
fessor of Anatomy at Rome, one of the most celebrated 
anatomists of that period, and a man of his own age, entered 



346 GROWTH OF MEDICINE 

the lists as the champion of Galen, Vesalius took up the 
challenge, left the work upon which he was then engaged, 
and began a tour of visits to the universities of Padua, 
Bologna and Pisa, for the express purpose of disproving, 
by the aid of numerous dissections, the statements made 
by his antagonists. Throughout this tour he was received 
everywhere with enthusiasm, the older men among the 
teachers of anatomy vying with the younger in manifesting 
the strength of their approval. The entire journey, says 
Haeser, was from beginning to end a series of the most 
brilliant triumphs. But, notwithstanding this vindication, 
which most men would have accepted with the greatest 
satisfaction, Vesalius returned to his home in Brussels only 
to find that the bitter attacks made by his enemies had not 
ceased. This depressed him greatly, for he was not 
philosophical enough to recognize the facts that jealousy 
was at the bottom of this ill feeling toward him, and also 
that sufficient time had not yet elapsed for the news of his 
triumphant vindication to travel from Italy to Belgium. 
While suffering from this fit of the blues he committed to 
the flames all his books and manuscripts. These latter, it 
appears, contained not only the fruits of many years of 
laborious anatomical and physiological research, but also 
a large number of memoranda relating to pathological 
anatomy. 

In 1556, complaints having reached the ears of Charles 
the Fifth to the effect that the sin of dissecting human 
corpses was greatly on the increase, this monarch decided 
to refer the question to the Theological Faculty of the 
University of Salamanca, in the northwestern part of 
Spain, for an authoritative opinion. The reply which these 
broad-minded theologians sent to the Emperor was most 
satisfactory. It is reported to have been expressed in the 
following words: "The dissection of human cadavers 
serves a useful purpose and is therefore permissible to 
Christians of the Catholic Church. ' ' This decision did not 
of course put an immediate end to the harsh criticisms and 
petty persecutions of the bigots ; but, as the years went by, 
it was noted that the work of scientific research in human 



HUMAN ANATOMY AND PHYSIOLOGY 347 

anatomy and physiology acquired greater freedom of 
action, and it is fair to assume that this result was largely 
due to the famous decision to which I have just referred. 

Shortly after Vesalius had retired, as stated above, from 
active participation in anatomical research work, he was 
called by Charles the Fifth to serve him in the capacity of 
private physician. During this service, which lasted for 
several years, he visited, in company with the Emperor, 
many of the principal cities of Europe ; and then, when the 
latter abdicated the throne of Spain, — for Charles was not 
only Emperor of the Holy Eoman Empire but also King 
of Spain, — Vesalius became the private physician of Philip 
the Second, Charles' son and successor on the Spanish 
throne. This long period is largely a blank in the history 
of Vesalius. Toward the end he got into trouble with the 
Inquisition and was obliged, as a means of escaping the 
punishment of death, to undertake a voyage to the Holy 
Sepulchre in Jerusalem. While he was in that city he 
received an official invitation from the Senate at Venice 
to fill the Chair of Anatomy at Padua. He then at once 
turned his steps toward Italy, doubtless very happy over 
the prospect of once more engaging in anatomical work; 
but he was shipwrecked on the coast of the Island of Zante, 
October 2, 1564. Thirteen days later, before he had com- 
pleted his fiftieth year, he died from starvation and 
exposure. A memorial tablet was placed in one of the 
neighboring churches on the island, and in 1847 his Belgian 
compatriots erected a suitable monument to his memory 
in the city of Brussels. 

Admirable as was Vesalius' treatise on human anatomy, 
it was soon discovered that it was deficient in certain 
particulars. Not a few of the descriptions, for example, 
were incomplete, and there were also a number of parts or 
organs for which no descriptions whatever had been 
provided. Many of these deficiencies were supplied by 
contemporary anatomists, nearly all of whom were Italians. 
First and foremost among this secondary but yet very 
important group of laborers in the field of original 



348 GROWTH OF MEDICINE 

research work, the names of Fallopius and Eustachius 
deserve to be mentioned. 

Gabriele Fallopius, who was born in Modena in 1523, 
was appointed to the Chair of Anatomy at Ferrara when 
he was only twenty-four years of age. Subsequently he 
taught at the University of Pisa. At the time of his death 
in 1563 he was Professor of Anatomy, Surgery and Botany 
at Padua. He made many important discoveries in anat- 
omy, more particularly in relation to foetal osteology and 
the distribution of the blood-vessels. His work in the latter 
department is all the more remarkable from the fact that 
it was accomplished at a time when the art of injecting 
blood-vessels with some opaque material was unknown in 
Italy. His name has been perpetuated in connection with 
the Fallopian tube. As a man Fallopius was much liked 
because of his kindly disposition and absence of conceit. 
The only treatise which he published was that entitled 
^^Ohservationes anatomicae,^* Venice, 1561. 

Bartholomaeus Eustachius, born at San Severino, in the 
Marches of Ancona, in the early part of the sixteenth 
century, was one of the most distinguished physicians of 
his day. He taught anatomy at the famous University of 
Sapienza at Rome, and devoted a great deal of time and 
thought to the preparation of a large work which was 
to bear the title ''On the Dissensions and Controversies 
Relating to Anatomy"; but death overtook him before he 
had completed this undertaking. It appears, however, that 
in 1564^that is, ten years before he died — he published a 
smaller work containing separate chapters on the kidneys, 
the organ of hearing, the movements of the head, the vena 
azygos, the vena profunda of the arm, and on certain 
questions relating to osteology; and he introduced, as 
illustrations for the text, eight plates of octavo size. These 
plates and thirty-eight others, which were to have served 
as illustrations for the great work, were all completed as 
early as during the year 1552. The artist Pini, who made 
the drawings that served as the originals from which the 
plates were made, was related in some degree to Eustachius, 
and upon the latter 's death the metal plates became his 



HUMAN ANATOMY AND PHYSIOLOGY 349 

property by inheritance. But nothing further was heard 
of them until they were discovered, early in the eighteenth 
century, by Lancisi, the Pope's attending physician, in the 
possession of Pini's descendants. They were published 
for the first time in 1714. Haeser says that these pictures 
are true to nature, but that in artistic merit they are not 
equal to those which belong to the treatise published by 
Vesalius. The name Eustachius is permanently connected 
with the channel which leads from the tympanum to the 
nasal cavities — the Eustachian tube. 

Only the briefest possible mention may here be made 
of those anatomists who, following immediately in the foot- 
steps of the three great leaders mentioned above, played 
parts of greater or less importance in building up the 
science of anatomy. Each one of them did creditable work 
in correcting the errors made by their predecessors or in 
supplying descriptions of structures or structural relations 
which these pioneers had overlooked. Thus, long before 
the sixteenth century came to an end, the gross anatomy 
of the human being had attained a large measure of the 
completeness which it possesses to-day. The names of 
some of the more prominent men among those to whom 
I have just referred are the following: Giovanni Filippo 
Ingrassia, Matthaeus Realdus Columbus, Julius Caesar 
Arantius, Constantius Varolius, Volcher Koyter and 
Hieronymus Fabricius ab Acquapendente. 

Ingrassia (1510-1580), a Sicilian physician, cultivated 
osteology assiduously, and is entitled to special credit for 
having first described the stapes, the third one of the 
ossicles of hearing, and for having made valuable contri- 
butions to our knowledge of epidemic diseases. He was a 
professor in the University of Naples, and, after the year 
1563, held the position of Archiater in Palermo, Sicily. 
His descriptions of the diiferent bones of the skeleton were 
made with such care and thoroughness that later anatomists 
found very little for them to discover or to alter. 

Matthaeus Realdus Columbus (or simply Realdus 
Columbus), who died in 1559, was born in Cremona, 
Northern Italy. He served for some time as Prosector 



350 GROWTH OF MEDICINE 

to Vesalius at Padua, and then succeeded him in the Chair 
of Anatomy, first at Padua and afterward at Pisa. The 
last teaching position which he held was that of Professor 
of Anatomy in Rome, in which city he counted Michael 
Angelo among his intimate friends. The discoveries which 
he made in anatomy were quite numerous and of consider- 
able importance, and his descriptions were distinguished 
by an unusual degree of accuracy and clearness. Unfortu- 
nately, he did not hesitate, at the same time, to exalt the 
value of his own work by disparaging that of his famous 
teacher. 

Arantius, who also was one of the pupils of Vesalius, 
occupied the Chair of Anatomy in his native city of Bologna 
during the latter half of the century. His death occurred 
in 1589. The particular department in which he gained 
considerable fame was that of the foetus, the placenta, the 
uterus, etc. His descriptions of these structures are 
written with very great care. Blumenbach gives him credit 
for having been the first anatomist to furnish a description 
of the pregnant uterus in its different stages. His earliest 
published work bears the title ^^De humano foetu opus- 
culum,'^ Rome, 1564. 

Constantinus Varolius, whose name is imperishably 
connected with that part of the brain which is known as 
the "Pons Varolii," was born in Bologna in 1543. He was 
appointed Professor of Anatomy in the Academy of his 
native city at an early age, and soon distinguished himself 
by the careful studies which he made of the human brain 
and nervous system in general. Before his untimely death 
at the age of thirty-two he was chosen the attending 
physician of Pope Gregory the Thirteenth. His earliest 
published work bears the title *'Z)e nervis opticis, etc., 
epistola," Padua, 1573. 

Volcher Koyter, who was born at Groningen, North 
Holland, in 1534, studied under Fallopius and Guillaume 
Rondelet (1507-1566), to whom the University of Mont- 
pellier was indebted for its anatomical theatre, and to 
whom (rather than to Gaspard Bauhin of Basel) is due 
the honor of discovering the ileo-caecal valve. Koyter was 



HUMAN ANATOMY AND PHYSIOLOGY 351 

one of the earliest workers in the field of comparative 
anatomy — a department of knowledge to which Vesalius 
had already made some creditable additions ; and his two 
most important published treatises bear these titles: 
'*Z)e ossibus et cartilaginihus corporis Jiumani tabulae^* 
(Bologna, 1566), and ^^Externarum et internarum princi- 
palium humani corporis partium tabulae^ ^ (Nuremberg, 
1573). He died in 1600. 

Hieronymus Fabricius was born in 1537 at Acquapen- 
dente, a small city of Etruria, about fifty miles northwest 
of Rome. He studied anatomy at Padua under Fallopius, 
and, after the latter 's death, was assigned to the duty 
of making the necessary dissections and anatomical demon- 
strations before the class. In 1565 he was appointed 
Professor of Surgery, with the understanding that he was 
to continue giving his demonstrations in anatomy. The 
salary which he received for this double work was 100 
ducats, but it was increased from time to time until finally 
he was paid 1100 ducats yearly. At the end of thirty-six 
years he was retired upon a pension of 1000 ducats for the 
remainder of his life, and was allowed the privilege of 
appointing his successor in the Chair of Surgery. He gave 
the place to Julius Casserius in 1609. To distinguish 
him from another Fabricius, who gained great distinction 
in the field of surgery, it has always been customary for 
later historical writers to speak of him as ** Fabricius ab 
Acquapendente. " His namesake is known as ''Fabricius 
Hildanus. ' ' 

As a teacher of anatomy, especially in its relations to 
physiology, Fabricius was held in the highest esteem. 
Albert von Haller speaks of him as being one of the glories 
of the Italian school of medicine. Pupils came in flocks 
from all parts of Europe to attend his lectures, and among 
them were some who, like William Harvey of England, 
afterward attained great celebrity for the effective work 
which they did in advancing the science of medicine. One 
of the attractive features of Fabricius' teaching was to be 
found in his practice — something quite new at that period — 
of showing to the students, not only the particular organ 



352 GROWTH OF MEDICINE 

(human) upon which he happened then to be lecturing, but 
also the corresponding organ in one or several of the 
animals ; thus enabling them to learn what were the features 
possessed in common by all the species, and what were 
those in respect of which the species differed. As time 
went on, the number of those who came to witness his 
anatomical demonstrations increased so greatly that he 
felt impelled to build, at his own expense, a new and larger 
amphitheatre. But even this, in a short time, proved to 
be too small, and then the Senate at Venice, which exercised 
a governing control over the University of Padua, erected 
(in 1593) a much larger and more complete amphitheatre, 
upon the walls of which there was placed an inscription 
stating that it had been built in honor of Fabricius. Among 
the other distinctions which were conferred upon him at 
this time he was raised to the rank of Knight of the Order 
of Saint Mark and made an honorary citizen of Padua. 

Fabricius ab Acquapendente added to our stock of 
anatomical knowledge by his researches on the structure 
of the oesophagus, stomach and intestines, the eye, ear, 
larynx and foetus. One of his chief claims to distinction, 
however, rests upon the fact that he wrote an elaborate 
monograph on the valves of the veins. Although these 
structures had been seen and described at an earlier date 
by Charles Estienne, Berengarius, Vesalius, Cannani and 
others (Fra Paolo Sarpi, for example), nobody had yet 
offered a satisfactory explanation of their probable use 
or had traced them through the venous system at large. 
In 1574 Fabricius demonstrated their presence in all the 
veins of the extremities. 

But Fabricius ab Acquapendente was not merely a good 
anatomist and physiologist; he was also a most distin- 
guished surgeon and general practitioner. From far and 
from near patients came to consult him about their ailments, 
and he appears to have been immensely popular among all 
classes of the community. His home, situated on the River 
Brenta, just outside the city of Padua, was most attractive, 
and it was there that he dispensed hospitality in a princely 
fashion. One of his peculiarities was that in many cases 



HUMAN ANATOMY AND PHYSIOLOGY 353 

he was unwilling to accept a fee for his services. As a 
natural result, gifts of all sorts, many of them of consid- 
erable value, were showered upon him. He devoted one of 
the rooms of his residence to the purposes of a cabinet or 
museum, in which all those gifts which were suited to such 
display might be properly exposed to view, and over the 
doorway of the room he placed this inscription, ^^Lucri 
neglecti lucrum/^ which I venture to render into English 
by the following, '* Costly gifts representing unproductive 
wealth. ' '^ 

Fabricius remained a bachelor all his life, and at the time 
of his death (May 21, 1619, at the age of eighty- two) his 
fortune, which he bequeathed to his brother's daughter, 
amounted to 200,000 ducats — a very large sum in those 
days. 

The writings of Fabricius were published at Leipzig in 
a single volume in 1687, but Johann Bohn, who edited the 
collection, omitted the different prefaces which Fabricius 
had written. In the Leyden edition of 1737 this defect has 
been remedied. 

To furnish here even a much abbreviated account of the 
important discoveries made in anatomy and physiology 
during the sixteenth century would call for a much larger 
amount of space than can possibly be given to these two 
branches of medical science. Our modern text books on 
the subject of anatomy alone are, in a certain sense, cata- 
logues of these very discoveries, and every physician knows 
what a vast amount of space they occupy. I have already 
made mention of a few of these discoveries, and, when I 
come to consider the splendid work done by William Harvey 
in the early part of the seventeenth century, I shall have 

2 The meaning of this Latin inscription can best be appreciated by those 
physicians who have, through a long period of years, practiced their profession 
largely among the well-to-do classes of a metropolitan city. They alone, I 
believe, would understand the significance of "lucrum neglectum" as applied 
to a large proportion of the gifts which a practitioner of medicine receives 
from grateful patients; and it is not at all likely that a layman who is not 
familiar with this aspect of a physician's life would, under the circumstances 
mentioned, have the slightest suspicion that the device quoted above could 
possibly bear the meaning that I have given to it. 



354 GROWTH OF MEDICINE 

occasion to recapitulate briefly the more important dis- 
coveries made by his predecessors in this particular field. 
In this way I shall be able to supply information regarding 
several of the discoveries which I am now obliged to pass 
over in silence, but which, under other circumstances, would 
more properly receive consideration in the present chapter. 



CHAPTER XXVIII 

FURTHER DETAILS CONCERNING THE ADVANCE 
IN OUR KNOWLEDGE OF ANATOMY— DISSECT- 
ING MADE A PART OF THE REGULAR TRAINING 
OF A MEDICAL STUDENT— lATROCHEMISTS 
AND lATROPHYSICISTS— THE EMPLOYMENT 
OF LATIN IN LECTURING AND WRITING ON 
MEDICAL TOPICS 

Further Details Concerning the Advance in Our Knowl- 
edge of Gross Anatomy. — In the preceding chapter I have 
given some account of the efforts made during the sixteenth 
century by certain physicians to lay solidly the foundations 
of a gross anatomy of the human body. The time was ripe 
for such a movement, and the right sort of men took charge 
of it and pushed it forward to such a stage of successful 
accomplishment that we physicians of to-day are able to 
continue in the direction indicated, and under the impulse 
communicated, by these master builders. These men, it 
should be remembered, did something more than merely 
to lay solid and durable foundations in the form of an 
accurate anatomy, they also taught the correct methods of 
procedure for the erection of the superstructure of the 
science of medicine. 

Up to the end of the sixteenth century almost all the work 
done in anatomy was effected with the aid of the scalpel 
alone, the object being to isolate and expose clearly to view 
the larger tissues and organs, such as muscles, arteries, 
veins, nerves, etc. In a very few instances mor^ elaborate 
methods were devised, even as early as during the fifteenth 



356 GROWTH OF MEDICINE 

century, by men of exceptional (Ueverness. Thus, for 
example, in 1490, Alexander Benedetti, Professor of 
Anatomy at Padua, invented a ibethod of preserving 
muscles, nerves and blood-vessels as permanent dry speci- 
mens, and it is said that he sold such preparations for large 
sums of money. As already stated on a previous page, the 
injection of blood-vessels with certain fluids was also 
employed to a very limited extent at this early period as 
a means of distinguishing them more easily from the 
surrounding structures ; but this practice gave place, during 
the seventeenth century, to the better method of employing, 
as an injecting material, a semi-fluid preparation which 
became quite solid soon after it had penetrated well into 
the interior of the vessels, and to which any desired opaque 
color might be given. This method was invented by the 
Hollander, John Swammerdam (1627-1680) and perfected 
by Van Home. It was largely by the employment of this 
procedure that Friedrich Ruysch of Amsterdam (1638- 
1731), Professor of Anatomy and Botany in the university 
of his native city, gained such celebrity throughout Europe 
for the great beauty of his permanent anatomical prepara- 
tions. Hyrtl mentions the fact that Peter the Great of 
Russia, who resided for a certain length of time at Zaandam, 
near Amsterdam, in order that he might familiarize himself 
with the art of ship-building, was in the habit of visiting 
Ruysch from time to time in his museum and laboratory; 
and finally (in 1717) bought from him, for the sum of 30,000 
florins, his entire collection of specimens, together with the 
formula of the mixture which he employed in making his 
injections. The collection itself, it should be stated, con- 
tained not only specimens illustrative of normal human 
anatomy {e.g., the various solid and hollow organs, the 
organs of special sense, and objects belonging to the 
vascular, muscular, nervous and osseous systems), but 
also many specimens illustrating pathological and com- 
parative anatomy, and a great variety of monstrosities. 

Ruysch also attained remarkable success in restoring the 
rosy color and soft flexibility of the skin and the natural 
facial expression in certain dead bodies by the employment 



ADVANCE IN KNOWLEDGE OF ANATOMY 357 

of a preservative fluid widely known as ^^ Liquor balsam- 
icus.'*^ Tradition says that in one instance, that of a child 
whose corpse had been treated in this manner by Enysch, 
the face presented such a perfectly life-like appearance that 
the Czar, as he passed near the object, thought he was 
looking upon a sleeping child and gave it a kiss. 

The aged professor lived to be ninety-three, and con- 
tinued giving his lectures on anatomy almost up to the day 
of his death, which resulted from accidental injuries. 
When it became clear that these Avere of so serious a nature 
that he could not possibly recover, he asked to be carried 
on a stretcher into the assembly room in order that he 
might say a farewell to the students who had been attending 
his lectures. 

Although some critics have intimated that Ruysch should 
be ranked merely as a very clever mechanic in the domain 
of anatomy, there are certain well-established facts which 
show that this estimate of the man is unfair. It is known, 
for example, that he was the first anatomist to call attention 
to the features which distinguish the male from the female 
skeleton {e.g., the differences in the form of the pelvis and 
of the thorax). Ruysch also advanced our knowledge of 
the vascular system by means of the improvements which 
he effected in the method of injecting blood-vessels. His 
skill in this special work was so great that people were 
wont to say of him that he possessed the fingers of a fairy 
and the eyes of a lynx. It was Ruysch too who furnished 
the first descriptions of the bronchial blood-vessels and of 
the vascular plexuses of the heart. Finally, the term 
'^memhrana Rupschiana,^' in connection with the choroid 
of the eye, bears testimony to the fact that he was also an 
original worker in this very difficult corner of the field 
of human anatomy. 

The crowning event in the life of Ruysch — an event which 
shows how wasteful many of us men are of our productive 
powers when we deliberately retire from all participation 
in active work, physical or mental, at the comparatively 
early age of sixty-five — occurred in 1717, when he had 
attained the age of seventy-nine. Peter the Great had 



358 GROWTH OF MEDICINE 

hardly left the premises with the great collection of speci- 
mens for which he had paid such a fabulous price, when 
Ruysch began the making of a new collection; and at this 
task he worked so diligently that in less than ten years he 
was able to deliver to John Sobieski, King of Poland, the 
greater part of the new collection (for which he received 
the sum of 20,000 florins). Then followed a period of 
about three years during which he continued active work 
as a teacher of anatomy, death alone seeming to possess 
the power to arrest his extraordinary energy. 

Euysch's only published works are the following: 
Catalogue of the Specimens contained in his Museum, 
Amsterdam, 1691; and a Thesaurus Anatomicus, in 10 
volumes, Amsterdam, 1701-1715. 

In reading over the account which I have given of the 
discoveries made in gross anatomy and in physiology 
during the sixteenth and seventeenth centuries, I find that 
I have omitted some that may just as appropriately be 
mentioned in this section as in that which I intend to 
devote to work done in the domain of minute anatomy. 
I shall therefore refer to them briefly now, and then pass 
on to the consideration of the latter branch of my subject. 

Eustachius, the famous Italian anatomist, deserves 
special credit for the experimental methods which he 
devised and employed in his efforts to gain a better knowl- 
edge of the anatomy and physiology of the kidneys. 
Moritz Hofmann of Fiirstenwald discovered in 1641, in the 
turkey gobbler, the outlet duct of the pancreas, and a short 
time afterward George Wjrsung, a Bavarian, discovered 
the same structure in the human being. Then, in 1651, 
Olaus Eudbeck, Professor of Anatomy in the University 
of Upsala, Sweden, discovered the lymphatics of the 
intestines, and established (at a later date) the fact that 
they are a separate system from that of the chyle ducts. 
Francis Glisson (1597-1677) of Cambridge University, 
England, one of Harvey's pupils, made two series of 
anatomical investigations of a most creditable character — 
the first concerning the relationship which exists between 
the intestinal lymphatics and the alimentary canal, and the 



ADVANCE IN KNOWLEDGE OF ANATOMY 359 

second regarding the internal construction of the liver 
('' capsule of Glisson"). Thomas Wharton (1610-1673), a 
native of Yorkshire, England, and a London practitioner 
of medicine, discovered the outlet channel of the sub- 
maxillary salivary gland, now known as ** Wharton's 
duct," and he also published the first exhaustive treatise 
on the structure of glands in general (thymus, pancreas, 
submaxillary, etc.)- About the middle of the seventeenth 
century Nathanael Highmore of Oxford, England (1613- 
1685), discovered and adequately described the cavity in 
the superior maxilla which bears his name (** antrum of 
Highmore"), and which in comparatively recent years has 
assumed such importance from the viewpoint of the 
practical surgeon. A Danish anatomist, who is known to 
us English-speaking physicians as Nicholas Steno (1638- 
1686), but to his own coWtrymen as Niels Stensen, dis- 
covered the outlet duct of the parotid gland C Steno 's 
duct"). Stephen Blancaard (1650-1702), a practicing 
physician of Amsterdam, made the first successful injec- 
tions of capillary blood-vessels; and Domenico de Mar- 
chettis (1626-1688), Professor in the University of Padua, 
employing Blancaard 's technique, succeeded in proving 
that the finest ramifications of both veins and arteries 
communicate the one with the other. To Conrad Victor 
Schneider, a professor at the University of Wittenberg, 
Germany (1614-1680), we are indebted for putting an end 
forever to the erroneous doctrine that the nasal mucus 
is produced in the brain. He did not, however, have the 
good fortune to discover the glands from which this mucus 
actually comes; the credit for this discovery being due to 
Niels Stensen. Among the host of other successful dis- 
coverers in the domain of anatomy during the seventeenth 
century the following men deserve at least to be mentioned 
by name: Johann Conrad Peyer (1653-1712) of Schaff- 
hausen, Switzerland; Johann Conrad Brunner (1653-1727), 
also a native of Switzerland; Theodor Kerckring (1640- 
1693) of Hamburg, Germany; Anton Nuck (1650-1692), 
Professor of Anatomy at the University of Leyden, Hol- 
land; Reignier de Graaf (1641-1673), a native of the 



360 GROWTH OF MEDICINE 

Netherlands; and Thomas Willis (1622-1675) and William 
Cowper (1666-1709), both of them Englishmen. 

And, finally, it may be stated that all the leading anat- 
omists of the sixteenth century devoted a great deal of time 
to the study of the manner in which the nerves are dis- 
tributed throughout the body and to ascertaining the 
arrangement of the intracranial and intraspinal nervous 
structures. To give even the most superficial account of 
what these men accomplished would occupy far more 
space than can well be spared for this purpose. Kurt 
Sprengel is my authority for saying that, of all the workers 
in this particular field during the period in question, 
Fallopius is entitled to receive the greatest credit for what 
he accomplished. 

The First Beginnings of Minute or Microscopic Anat- 
omy. — The anatomy of the tissues — microscopic anatomy — 
begins with Marcello Malpighi (1628-1694), a native of 
Crevalcuore, near Bologna, Italy. It is not positively 
known who was the inventor of the compound microscope. 
First employed about the year 1620, the instruments of this 
type came into fairly general use toward the middle of the 
seventeenth century. But the early compound microscopes 
were not very satisfactory, and consequently preference 
was given, for a long time, to those of the simple type. 
Achromatic instruments were not purchasable until 1780, 
when the famous German physicist, Leonhard Euler, 
succeeded in overcoming the obstacles which had up to that 
time stood in the way of their successful manufacture. 

In 1661 Malpighi, who was in the habit of manufacturing 
his own microscopes, was able, by aid of one of these 
instruments, to exhibit the blood, loaded with its corpuscular 
bodies, passing rapidly from one capillary vessel to 
another in the frog's lung. Then in 1683 Guillaume 
Molyneux, in 1690 Anton van Leeuwenhoek, and in 1697 
William Cowper, witnessed the same phenomenon in warm- 
blooded animals. Among the other anatomists of this 
period who contributed in varying degrees to our knowl- 
edge of the minute anatomy of the different tissues and 
organs the following deserve to be mentioned: J. Riolan 



ADVANCE IN KNOWLEDGE OF ANATOMY 361 

(1577-1657), Boselli of Naples (1608-1679), Lower of 
Oxford, England (1631-1691), Vesling of Minden, Germany 
(1598-1649), Regnier de Graaf of Delft, Holland (1641- 
1673), who gained so great distinction by his accurate 
description of the ovarian follicles (*' Graafian follicles") ; 
and James Douglas (1676-1742), the English anatomist, 
who ascertained and described the precise limits of the 
peritoneum. 

Of all the men whom I have mentioned above, Malpighi 
and Leeuwenhoek are probably the best known to our 
readers for the large number and important character of 
the contributions which they made to microscopic anatomy. 
The list of Malpighi 's achievements, for example, includes 
the following, in addition to the demonstration of the blood 
in actual circulation, as already mentioned: contributions 
to our knowledge of the finer structure of plants; the 
demonstration of the minute anatomy of the skin {^Wete 
mucosum^^ or ^^rete Malpighi*^) ; the amplification of our 
knowledge of the structure of the teeth ; the discovery that 
the lungs are composed to a large extent of terminal 
vesicles, the walls of which are richly supplied with blood- 
channels; the demonstration that certain glands possess 
an acinous structure {i.e., an outlet channel springing from 
numerous small sacs, the whole group resembling a cluster 
of grapes) ; more complete details regarding the structure 
of the spleen and the kidneys (''Malpighian bodies or 
corpuscles") ; additions to our knowledge of the structure 
of the white and the gray substances of the brain and the 
demonstration that fibres from the spinal cord pass on into 
the brain; the declaration that the papillae of the tongue 
are organs of taste and the papillae of the skin are organs 
of the sense of touch; and not a few other contributions 
of greater or less importance. During his long life Anton 
Leeuwenhoek (1632-1723) of Delft, Holland, made a great 
many additions to microscopic anatomy, some of the more 
important of which are the following: he was the first to 
discover and to describe the many varieties of Infusoria 
(the animalcules found in stagnant collections of water) ; 
to him is also due the credit of first observing the faceted 



362 GROWTH OF MEDICINE 

arrangement in the eyes of insects; he made original 
investigations into the origin and mode of development 
of several species of the lower organisms ; he was the first 
to observe the canaliculated mode of construction in bone, 
and he also noted the existence of the so-called bone- 
corpuscles (afterward rediscovered and more accurately 
described by Purkinje) ; he discovered the striated condi- 
tion of the bundles of muscular fibres, and was also the 
first person to teach the doctrine that the growth of muscles 
is effected by an enlargement of the primitive bundles of 
fibres and not by a multiplication of these structures; he 
taught further that muscle-substance consists of numberless 
small spheres; he was the first to describe the crystalline 
lens as a structure composed of fibres which are arranged 
in layers or sheets; in association with Guillaume Moly- 
neux he studied, under the microscope, the speed with 
which the blood-current travels in the blood-vessels; he 
made valuable observations on the nature of the sperma- 
tozoa; and, finally, the very first studies in bacteriology 
appear to have been made by Leeuwenhoek. As a result 
of his discovery of *' round, rod-shaped, thread-like and 
corkscrew-shaped bacteria" between the teeth of a human 
being, the theory was set forth that probably many diseases 
owe their origin to such ** little animals.'" 

The same idea, as will be shown farther on, occurred to 
the distinguished medical practitioner of Verona, Italy, — 
viz., Fracastoro, — one hundred years earlier (1546). 
Leeuwenhoek, it should here be stated, possessed a very 
great advantage over his rivals in the field of minute 
anatomy, for he was in the habit of using, in his investi- 
gations, microscopes which he himself had made, and which 
magnified from 160 to 270 diameters, whereas those utilized 
by the others were capable of magnifying, at the maximum, 
only 143 diameters. While a large part of the work which 
he performed shows plainly that he was a skilful and 
careful anatomist and endowed with good mental powers, 

1 See F. Loeffler : ' ' Vorlesungen uber die geschichtliche Entwickelung der 
Lehre von den Bakterien," Leipzig, 1887, Th. 1; and also p. 310 of Pusch- 
mann's "Geschichte des Medieinischen Unterrichts, " Leipzig, 1889. 



ADVANCE IN KNOWLEDGE OF ANATOMY 363 

Leeuwenhoek nevertheless manifested certain mean traits 
of character. Daremberg says that these ** consisted in his 
disposition to conceal his technical methods from his 
associates, and in his jealousy of others — as manifested, 
for example, toward Leibnitz, who had established a similar 
laboratory for research work in minute anatomy. These 
traits of character showed that fundamentally he was not 
a true lover of science, but rather an artisan. And yet, 
with all these faults, he does not appear to have placed 
an inordinately high value upon his discoveries or to have 
beei^ unreasonably sure of the correctness of his conclu- 
sions." The first monograph published by Leeuwenhoek 
bears the date 1673. It is a study of the minute anatomy 
of the bee's sting. He was the first to declare that the blood 
is the nutritive fluid par excellence, and that it is to be 
found in the entire series of organisms belonging to the 
animal kingdom. He divided blood into two parts — the 
red, or the solid portion, and the serum. The corpuscles 
which float in the serum and give to the whole fluid its red 
color, are called by him *' particles, " in the case of blood 
from birds, reptiles and fishes, and ''globules" in that from 
quadrupeds. He employed this term ** globules" because 
he believed that these bodies were exactly spherical in 
shape. According to Daremberg, Leeuwenhoek 's studies 
cover the entire field of human histology, and his findings 
are for the most part correct. 

The Founding of Organizations for the Advancement of 
Medical Science. — During the seventeenth century there 
were formed a number of associations which had for their 
object the promotion of scientific knowledge, and these 
organizations contributed greatly to stimulate original 
researches in anatomy and physiology and to secure 
accuracy in the published results. Perhaps the most 
important institution of this kind was the French Academic 
des sciences, which was founded in 1666, and which deserves 
the credit of having taken a very important part in the 
perfecting of our knowledge of anatomy and physiology. 
The Royal Society of London, founded in 1645, possesses 
a splendid record of valuable work accomplished. The 

/ 



364 GROWTH OF MEDICINE 

following organizations also deserve to be honorably men- 
tioned in this place: the Accademia del Lincei at Rome, 
founded in 1603 ; the Academie des Curieux de la Nature, 
1652 ; and the Accademia del Cimento, founded at Florence 
in 1657. New universities were also founded in Germany. 

During the second half of the seventeenth century there 
were three French physicians who deserve credit for the 
excellence of the work which they did in the departments 
of anatomy and physiology, viz., Vieussens, du Verney and 
Dionis. 

i ■'Raymond Vieussens (1641-1716), a native of Rovergue, 
was Professor of Anatomy at the University of Mont- 
pellier, in Southern France. Some idea of the extraordi- 
nary industry displayed by this anatomist may be gained 
from the fact that he is credited with having dissected 
more than five hundred bodies. His more important 
published works relate to the heart, the nervous system 
and the structures of the organ of hearing. Pagel speaks 
of him as being entitled to the name of founder of the 
pathology of diseases of the heart. 

Jean Guichard du Verney (1648-1730), who held the 
Chair of Anatomy in the University of Paris, gained a large 
part of his fame as an anatomist from the excellence of 
his investigations into the complicated structures of the 
internal ear. 

Pierre Dionis, who died in 1718, was Demonstrator of 
Anatomy and Surgery at the Jardin du Roi in Paris during 
the latter part of the seventeenth century and early part 
of the eighteenth. In 1690 he published a treatise on 
anatomy which remained the standard book on this subject 
for a number of years. In course of time it was translated 
into the Latin, English, German and Chinese languages. 

Dissecting Made a Part of the Regular Training of a 
Medical Student. — The opportunities for dissecting human 
bodies varied greatly in different parts of Europe during 
the period of which I am now treating. Vieussens, as 
we have just seen, dissected no fewer than five hundred 
bodies during his long professorship at Montpellier; and 
Joseph Lieutaud, Professor of Anatomy at Paris, dissected 



ADVANCE IN KNOWLEDGE OF ANATOMY 365 

more than twelve hundred bodies during the continuance 
of his connection with that institution. So far as I have 
been able to learn from my examination of the literature, 
the professors and their immediate oflScial assistants were 
the only persons who had, up to this time, derived the 
principal benefits that flow from work of this nature; the 
students merely listened to the instructor's remarks upon 
the objects which had previously been exposed to view by 
dissection. But toward the end of the period — a little \ 
before or shortly after the beginning of the eighteenth 
century — facilities were provided in some of the medical 
schools, and before long in all of the leading ones, for the 
students themselves to participate in this highly important 
part of a physician 's education. The value of such training 
was emphasized by the statement made by the English 
philosopher, John Locke (1632-1704), toward the end o*f his 
life, viz., that all human understanding is based upon 
experience. He wrote that at birth the human soul is like 
a clean sheet of paper upon which all the objects perceived 
by the senses are recorded as experiences, and there they 
remain until by the aid of reflexion — i.e., by the aid of the 
understanding, which Locke calls the inner sense — they are 
combined into conceptions or ideas. Locke, it should be 
remembered, was educated as a physician, but he never 
took his degree, nor did he ever practice medicine. 

The first stimulating effects of the Renaissance upon the 
devotees of the science of medicine were felt in Italy toward 
the end of the fifteenth century, and these effects rapidly 
gained in intensity during the following century. First 
France and afterward Switzerland, Belgium, Holland and 
England were almost simultaneously brought under the 
same influence; and in all these countries the students 
manifested a remarkable eagerness to acquire all the 
knowledge they possibly could. In Germany, however, the 
influence of the Renaissance did not make itself felt until 
a much later date, and the thirst for knowledge was very 
much slower in developing than was the case in any of the 
other countries mentioned. Thus Puschmann, in his 
** History of Medical Education," makes the following 



366 GROWTH OF MEDICINE 

statement which shows clearly that in Germany the univer- 
sity students of that period must have been a very rough 
set of men: ''In 1625 the Senate of the University of 
Leipzig was obliged to warn its students that they must 
cease disturbing wedding festivals and handling the guests 
roughly, that they must no longer make obscene remarks 
to married women and maidens, etc. And in 1631 a physi- 
cian named Lotichius, in writing to a friend, made the 
statement that 'in our German high schools the students 
seem to prefer strife to the reading of books, daggers to 
copy-books, swords to pens, bloody encounters to learned 
discussions, incessant boozing and noisy reveling to the 
quiet pursuit of their studies, and public-houses and 
brothels to students' work-rooms and libraries.' " In 
1660 the students at Jena, on one occasion, carried on a 
regular battle with the police, and as a result of this 
encounter several persons were killed. In the light of this 
evidence, therefore, it is not surprising that the science 
of medicine made comparatively little advance in Germany 
until after the eighteenth century was reached. 

latrochemists and latrophysicists. — During the seven- 
teenth century there was a great deal of disputing among 
physiologists about the nature of certain processes like 
assimilation and retrograde metamorphosis, about the 
manner in which blood is formed, about digestion, and about 
the role played by the lymph vessels. According to Haeser 
a large proportion of the physicians of that day were 
confident that chemistry was entirely competent to solve 
these riddles, and yet, on the other hand, there were not a 
few who believed that the science of physics, which was 
then much further advanced than that of chemistry, was 
quite as competent to explain all the phenomena. At first 
the split into these two factions was confined to men who 
were interested in questions of a purely physiological 
nature, but in a short time the practitioners of medicine 
were also drawn into the controversy; and from that 
time onward it became customary to employ the terms, 
" latrochemists" and "latrophysicists" in speaking of the 
partisans of the two schools of medicine (the iatrochemical 



ADVANCE IN KNOWLEDGE OF ANATOMY 367 

and the iatrophysical or iatromeclianical). The iatro- 
chemists described digestion as an act that is essentially 
chemical in character, a form of fermentation; and by the 
latter term the more advanced members of this school — 
Francois Deleboe Sylvius (1614-1672), who was born in 
Hanau, Prussia, of Dutch parents, and who took his 
doctor's degree in Basel in 1637, and Thomas Willis of 
London (1622-1675) — understood something quite different 
from our modern conception of fermentation. Their inter- 
pretation was as follows : ' ' An internal chemical movement 
of nlatter which is set agoing and continued in action in the 
stomach and intestinal canal through the agency of certain 
chemical reagents. " (Haeser.) They attributed an impor- 
tant influence to the salivaT, the pancreatic juice and the 
bile in effecting the changes mentioned. The iatro- 
physicists, on the other hand, and more particularly 
Archibald Pitcairn of Edinburgh, Scotland (1652-1713), 
and Giorgio Baglivi of Eagusa, Italy (1668-1707), described 
digestion as a purely mechanical breaking up of the ele- 
ments of the food partaken — a ''trituration." As to the 
further fate of the resulting chyle (its mode of reaching 
the blood, for example) the two schools were in perfect 
accord. 

Sprengel mentions it as an actual fact that, during the 
seventeenth century, there were several physicians who 
combined the two careers of teacher of medicine and 
hydraulic engineer (iatrophysicists or iatromathemati- 
cians).^ Several events conduced to the formation, in 
Italy and in Great Britain, of a distinct iatromathematical 
school. Among them may be mentioned, first and foremost, 
Harvey's discovery of the circulation of the blood; second, 
the spread of the doctrines taught by Descartes favored 
in a marked degree the union of medicine and mathematics 
(physiology, the iatromathematicians claimed, was only a 
branch of applied mathematics) ; and, third, the formation 
at Florence, in the middle of the seventeenth century, of 
an association of the pupils of Galileo. The objects of this 

2 The iatrophysicists and the iatromathematicians constituted apparently 
two kindred branches of the same school. 



368 GROWTH OF MEDICINE 

association were to cultivate their master's philosophy, 
to carry on the work of experimental physics, and to apply 
its principles in every department of natural science. 
Alphonso Borelli (1608-1679), Professor of Mathematics 
first at Messina and afterward at Pisa, the author of the 
famous treatise on ' ' The Movements of Animals, ' ' and the 
founder of the iatromathematical school, was a member 
of the association. In this connection it is important to 
mention another zealous worker in the field of iatro- 
mathematics, viz., Sanctorius Sanctorinus, of Capo d'Istria 
(1561-1636). His work was done quite independently 
of any general movement among scientific investigators 
and at a much earlier period than that during which the 
school flourished. He was quite successful, for example, 
in his attempts to measure the actual amount of impercep- 
tible evaporation, and to determine the influence which this 
process exerts upon health and disease. In the course of 
these investigations in what he called ''static medicine," 
Sanctorinus invented a number of unusual instruments. 

The phenomenon of the formation of schools or sects, 
the members of which were keenly interested in the mainte- 
nance and promulgation of certain physiological, patho- 
logical, or therapeutic doctrines, manifested itself anew, 
as I have shown above, in the seventeenth century. In 
the early years of the Christian era the partisans of 
different medical doctrines formed schools of this nature 
which flourished for a certain period of time and then died 
out completely. Such, for example, were the sects of the 
Dogmatists, the Methodists, the Pneumatists, etc. The 
mere fact of the existence of these different schools or sects 
showed unmistakably that the science of medicine was alive 
at that time and that its devotees were making vigorous 
efforts to increase their stock of knowledge. Then followed 
the long period of the Middle Ages, a series of many cen- 
turies, during which medicine made only slight gains ; but 
at last came the Renaissance, — the fifteenth, sixteenth and 
seventeenth centuries, — and here again we have a recur- 
rence of the same phenomenon of sects in medicine; but 
note the great difference between the earlier manifestations 



ADVANCE IN KNOWLEDGE OF ANATOMY 369 

-and those which I have just outlined. The present group, 
it is proper to remark, is merely the forerunner of several 
similar movements that are to occur during the eighteenth 
and nineteenth centuries, movements that are all based, in 
varying degrees, upon the truth. 

The Employment of Latin in Lecturing and Writing on 
Medical Topics.— Ija-^ the countries of Europe, but more 
particularly in..6^many, there existed during the sixteenth 
and sevenWnth centuries — and for a long time subse- 
quently— t;he practice of delivering all the lectures on 
medicajktopics in the Latin tongue — i.e., in a language 
whi^lkat best could not be easily understood by more than 
a small proportion of the students. Even the lecturers 
themselves must have been hampered in the full expression 
of their thoughts by this rule, which was practically 
compulsory. Paracelsus (1493-1534), the famous Swiss 
physician, tried — a full century earlier, as will be shown 
farther on — to break up this seemingly harmless but in 
reality objectionable custom; his example, however, was 
not followed, and the practice was continued without 
interruption for at least two centuries longer. The use 
of Latin as the language in which all medical knowledge 
was to be taught was undoubtedly based upon the idea that 
it was necessary for the educated physician to be reason- 
ably familiar with that particular tongue, for the simple 
reason that it was the only one in which, in those early days 
in "Western Europe, the writings of Galen were accessible, 
for nobody but a few expert scholars had yet acquired any 
useful knowledge of Greek, the language in which all of 
Galen's works were originally written. But it is quite 
likely that with this motive, which certainly was intended 
to produce good and useful fruit, there was coupled the 
further idea that the great mass of irregular practitioners — 
the quacks, the early barber-surgeons (Wundaerzte), and 
the peripatetic physicians — would in this way be debarred 
from entering the ranks of the regularly trained physicians. 
It was only after the custom of using the Latin for 
lecturing and writing purposes had become thoroughly 
rooted in the minds of medical men as something right and 



370 GROWTH OF MEDICINE 

proper, that it began to dawn upon the minds of some of 
the brighter men that this practice was harmful to the 
advance of medicine beyond the standards established by- 
Galen. Vesalius, who was a contemporary of Paracelsus, 
fully appreciated how serious an obstacle to further 
progress in anatomical knowledge the teachings of Galen 
were, and it was he who made the first really successful 
attack on this great hindrance to further progress; but 
there is no evidence to show that he had the slightest idea 
that lecturing and writing about medical topics in Latin 
played any part in the perpetuation of the evil which he 
was fighting. To Paracelsus alone belongs the credit, so 
far as I know, of endeavoring, through the force of example 
and by spoken arguments, to break up the practice which 
we are here considering. I may be mistaken in the view 
which I have here expressed, but it is difficult for me not 
to believe that the habitual use of Latin as the proper 
vehicle for the transmission of facts and ideas belonging 
to the domain of medicine must have materially hindered 
the advancement of that science; for such use certainly 
tended to keep men's minds moving in fixed ruts, and those 
ruts all led straight toward the faulty teachings of Galen. 



CHAPTER XXIX 

THE CONTEIBUTIONS MADE BY DIFFERENT MEN 
DURING THE RENAISSANCE, AND MORE PAR- 
TICULARLY BY WILLIAM HARVEY OF ENG- 
LAND, TO OUR KNOWLEDGE OF THE CIRCULA- 
TION OF THE BLOOD, LYMPH AND CHYLE 

Among the earliest known doctrines relating to the 
nature of the blood and its mode of distribution throughout 
the body are those attributed to Erasistratus and Galen; 
for the still more ancient ones, of which Diogenes of 
ApoUonia, Aristotle and the Hippocratic writers are 
reputed to be the authors, are too incomplete to call for 
serious consideration in this place. 

(a) The Doctrine Taught by Erasistratus. — Erasis- 
tratus, who was born at Julis in the Island of Ceos (Aegean 
Sea) during the third century before Christ, held the belief 
that the arteries contain only air, which is drawn into the 
lungs by way of the trachea and bronchi, whence it enters 
the pulmonary vein (called by him the ** venous artery"). 
In its further course this air passes from the pulmonary 
vein into the left ventricle of the heart, and is then conveyed 
from that organ through the arteries to the different tissues 
of the body. Erasistratus further taught that the smallest 
subdivisions of both the arteries and the veins lie side by 
side in the tissues, and that, in certain abnormal bodily 
conditions, they communicate the one with the other 
through anastomoses; but that, in a normal condition of 
the body, no communication takes place between the two. 
In common with all other physicians of that time, he 
believed that only the veins carry blood. Here, then, we 



372 GROWTH OF MEDICINE 

find the first glimmering of the truth with regard to the 
nature of the circulating medium and also with regard to 
the course which it pursues in one part of its circuit — that 
part, namely, where the two kinds of vessels become 
capillary in character. His substitution of air for blood 
in the arteries is plainly the principal error in his scheme. 

(6) The Teaching of Galen and of Caesalpinus with 
Regard to the Nature of the Blood and Its Mode of Dis- 
tribution. — Galen, in the second century of the present era, 
disputed the correctness of the doctrine taught by Erasis- 
tratus. His objections are thus stated: ''Inasmuch as 
blood flows from an artery when it is wounded, one of two 
things must be the truth. Either blood was already con- 
tained in the vessel before it was wounded, or it must have 
found its way in from the outside. But, if the blood comes 
from the outside into a vessel which contains only air, then 
air must necessarily escape from that vessel (when 
wounded) before blood does — which is contrary to the fact, 
as blood alone flows out. Therefore arteries contain only 
blood." As a further proof of the correctness of his 
statement Galen carried out the following experiment: 
In a living animal he placed two ligatures around an artery 
at points situated not far apart, and then made an opening 
in the vessel between the two ligatures. The intervening 
section of the artery, it was thus found, contained only 
blood. This experiment, it might reasonably be supposed, 
would have definitely settled the question; but such was 
not the case. The followers of Erasistratus immediately 
raised this objection: If the arteries contain blood, how 
may the air which is drawn into the lungs find its way to 
all parts of the body? Galen replied that the inhaled air 
does not pass through the lungs, but is rejected by them 
after it has cooled the blood. This refrigerating process, 
he claimed, constitutes the sole purpose of the respiratory 
act. 

Although Galen's idea regarding the true function of 
respiration is not in harmony with the doctrine taught by 
modern physiologists, it nevertheless represents a marked 
advance over the belief previously maintained. Even as 



CIRCULATION OF TEE BLOOD 373 

recently as in the time of Albert von Haller (approximately 
1760-1780) physicians still continued to believe that it was 
the function of respiration to cool the blood; and indeed 
it was scarcely possible before 1800 to offer a more correct 
physiology of the act of breathing, for it was not until 
after the lapse of many centuries that the advance in our 
knowledge of chemistry reached a point at which it became 
possible to find a satisfactory solution of so complicated 
a problem. 
V As to the nature of the blood itself Galen believed, as I 
have already stated more fully in Part I. (*' Ancient 
Medicine"), that there are two kinds — spirituous blood 
(or /spirit) and venous blood. He gave the name of 
spirituous blood to that which is found circulating in the 
arteries, and which is appreciably brighter in color than 
that which fills the veins. According to Flourens, the 
distinguished French physiologist of the nineteenth cen- 
tury, Galen was the first among the ancient anatomists to 
make this distinction of two different kinds of blood. To 
the spirituous variety Galen ascribed the function of 
nourishing the more delicately constructed organs like the 
lungs, while he claimed that the venous blood is suited to 
nourish only the coarser ones, like the liver, spleen, etc. 

In his further development of a physiology of the 
circulation of the blood Galen, who as a rule expresses his 
ideas with great clearness, makes statements which I find 
it extremely difficult to comprehend. I am therefore 
tempted to assume that the copyists, to whom we are 
indebted for handing down his actual words from age to 
age, are the persons upon whom should be cast the blame 
for the obscurity of which I complain. However this may 
be, it is an unquestionable fact that the ablest physiologists, 
were they to be confronted to-day with the duty of solving 
this problem of the circulation under the conditions of 
knowledge which existed during the third century of our 
era, would surely not be able to provide a more correct 
solution than that which is credited to Galen. The problem 
was attacked repeatedly by some of the brightest and best- 
equipped minds of the Renaissance period, but not one of 



374 GROWTH OF MEDICINE 

these exceptionally clever men was able to offer an entirely- 
acceptable solution. Harvey alone, as will appear farther 
on in this account, solved the riddle once and for all. 

The ^'spirit" — the purest part of the blood — is lodged, 
according to Galen, in the left ventricle ; and, inasmuch as 
even the venous blood, if it is to fulfil in some degree the 
function of a nourishing fluid, must possess a certain 
proportion of ** spirit," it is clear that the two ventricles 
should communicate the one with the other ; for how other- 
wise — thought Galen — is it possible for a certain amount 
of ** spirit" to commingle with the venous blood? The 
locality at which this communication was assumed to exist 
was the interventricular septum; and, as nobody was able 
to find anything like a foramen in this membrane, it was 
asserted that the communication is effected through an 
infinite number of pores. For over one thousand years 
physicians accepted this porous character of the inter- 
ventricular septum as an established fact. In his com- 
mentaries on Mondino's ''Anatomy" (1521), Berengarius 
of Carpi timidly ventured the statement that the openings 
of communication are not distinctly visible, and this appar- 
ently was the first feeble expression of doubt concerning 
the correctness of the prevailing doctrine. Vesalius, on 
the other hand, boldly denied their existence altogether. 

According to Galen's teaching the liver is the source 
of origin of all the veins, just as the heart is the starting- 
point of all the arteries. It is quite remarkable, says 
Flourens, that physicians who performed almost daily the 
operation of venesection should, during a long series of 
years, have failed to observe that this doctrine of blood 
flowing through the veins from the liver to the different 
parts of the body, could not possibly be true, inasmuch as 
at each such operation the vein always became distended 
with blood below {i.e., on the distal side of) the ligature 
which they applied to the part (arm, for example) before 
opening the vessel. This phenomenon, of course, indicated 
clearly that the blood in the veins flowed toward the heart, 
and not from any centrally located spot or organ toward 
the extremities. And yet — he adds — even so bright and 



CIRCULATION OF TEE BLOOD 375 

thoughtful a man as Vesalius does not appear to have 
noticed this fact. Andreas Caesalpinus (1519-1603), on 
the other hand, did observe and correctly interpret the 
phenomenon; and he made the further observation that 
physicians were habitually applying the ligature above the 
spot which they expected to bleed, regardless of the fact 
that in so doing they were not acting in harmony with their 
belief concerning the circulation of blood in the veins. 
Caesalpinus also states, in one part of his writings, that 
''the blood, carried to the heart by the veins, receives in 
that organ its last transformation toward perfection, 
and is then — in this perfected state — transported by the 
arteries to the remotest parts of the body." So far as it 
relates to the general movement of the blood this statement 
is correct, but it errs, as will be shown presently, in men- 
tioning the heart as the locality where the perfecting 
process takes place. In his final remarks regarding the 
anatomical relations which exist in the two chambers of 
the heart Caesalpinus makes the following statement: — 

Each ventricle possesses two vessels — one through which the 
blood reaches that chamber, and a second one which serves to carry 
it out of the ventricle. The vessel through which the blood enters 
the right ventricle is called the vena cava, and that by which it 
leaves this same chamber is called the pulmonary artery. The 
vessel through which the blood arrives in the left ventricle is called 
the pulmonary vein, and that through which it leaves this left 
chamber of the heart is known as the aorta. 

The Circulation of the Blood as Elucidated hy Michael 
Servetus. — Michael Servetus, a native of Villanueva, Spain, 
who in 1553 was burned alive at the stake near the city of 
Geneva, Switzerland, because of his heretical teachings, is 
not infrequently mentioned as the individual to whom credit 
is due for having furnished the first description of the 
lesser or pulmonary circulation. There is no question 
whatever regarding the justice of according to him at 
least a part of this honor, but one should be careful to 
specify that Servetus is entitled only to the credit of having 
been the first to teach that the blood, in its journey from 



376 GROWTH OF MEDICINE 

the right to the left side of the heart, must pass entirely- 
through the lungs. So far, his doctrine is correct; but 
he also taught at the same time that the fluid which enters 
the aorta from the left ventricle is not blood but perfected 
''vital spirit" (Galen), and that it becomes genuine blood 
only after it has tarried for a few brief instants in the 
ventricular chamber and has there been subjected to some 
unknown influence exerted by the heart itself. This second 
erroneous part of Servetus' description seems to me to 
diminish very materially the credit to which he is otherwise 
entitled ; and I cannot help feeling that Dezeimeris is right 
when he claims that Realdus Columbus, whose more perfect 
account of the lesser circulation was written only a little 
later than that of Servetus, is perhaps better entitled to 
the honor in question. 

It is an interesting fact that Servetus introduces his 
disquisition on the circulation of the blood in the very midst 
of a treatise which bears the title ''Restitution of Chris- 
tianity, ' ' — in other words, in a treatise which would never, 
under ordinary circumstances, be consulted by physicians 
in their search for information regarding an important 
problem in physiology like that of the circulation of the 
blood. In this physiologico-theological treatise Servetus, 
who — as I omitted to state — was a theologian as well as a 
physiologist, used the following expressions : — 

The soul, says Holy Writ, is in the blood; as a matter of fact, 
the soul is the blood. And since the soul is in the blood, one 
should — if one wishes to learn how the soul is formed — endeavor 
to learn how the blood is formed; and, in order to learn how the 
blood is formed, it is necessary to ascertain how it moves, 
(Flourens.) 

I am unable to state whether it was this particular 
chapter, or the work taken as a whole, which appeared to 
the ecclesiastical authorities — first those of France and 
afterward those of Geneva — to warrant the author's 
condemnation as a heretic. And, when we are disposed to 
blame severely those bigots who, in the fifteenth and six- 
teenth centuries, manifested such a keen desire to destroy 



CIRCULATION OF THE BLOOD 377 

** heretics," let us remember, with a proper sense of shame, 
that we still have in our midst, in this twentieth century 
and in this ' ' land of freedom, ' ' men of high social standing 
who are as virulent heresy-hunters as ever were the enemies 
of Servetus. 

Experiments of Realdus Columbus. — Matthaeus Kealdus 
Columbus, who was born at Cremona, Northern Italy, in 
the early part of the sixteenth century, acted for some time 
as Vesalius ' prosector, and must therefore have had ample 
opportiinities for acquiring a thorough knowledge of the 
experimental method of studying questions in physiolog)^ 
He wrote a description of the pulmonary circulation which 
was more lucid and nearer to the truth than any which his 
predecessors had furnished. This description, which will 
be found in his treatise on anatomy (Venice, 1559), was 
based largely upon experiments that he carried out upon 
living dogs. As rendered into English from the French 
version supplied by Dezeimeris, it reads as follows: — 

When the heart dilates the blood passes from the vena cava into 
the right ventricle; from the latter chamber it is pushed into the 
arterial vein (the pulmonary artery), along which channel it is 
carried to the lung, there to be properly thinned and mixed with 
air. Ultimately the blood passes on into the venous artery (= the 
pulmonary vein), the function of which vessel is to carry this fluid, 
now charged with air through the action of the lung, into the left 
ventricle of the heart. Then follows the contraction (systole) of 
this organ, as a result of which action the tricuspid valves rise up 
into position and form a dam that prevents the return of the blood 
into the vena cava and the pulmonary veins. Simultaneously with 
this action the valves placed at the opening which represents the 
commencement of the aorta (left ventricle), and those placed at 
the opening which corresponds to the beginning of the pulmonary 
artery (right ventricle), yield and thus open the way for the 
distribution of the blood throughout the rest of the body. 

The reader will, I believe, admit that this description, 
while perhaps not faultless, is distinctly superior to that 
given by Servetus. 

Columbus ' experimental studies threw considerable light 
upon other matters relating to the physiology of the heart. 



378 GROWTH OF MEDICINE 

He demonstrated, for example, that the fluid which enters 
the left ventricle from the lungs is genuine blood, and he 
also learned by the same method of investigation the true 
nature of the systole and diastole of the heart and the 
relations of these acts to the pulse and to the changes in 
the position of the heart. The discovery of all these facts 
constituted a material advance in our knowledge of the 
physiology of that organ; but, from this time onward, for 
a period of nearly three-quarters of a century, no further 
advance was made until William Harvey of England 
appeared on the scene. The explanation of the failure of 
such able investigators as Realdus Columbus, Vesalius, 
Servetus and others to push their researches still further 
is to be found largely in the fact that they were all still 
in bondage to the doctrines taught by Galen centuries 
earlier, and probably more particularly to that dogma which 
maintains that blood — ^if it is to be accepted as genuine or 
fully formed blood — must first have been elaborated in the 
depths of the liver. The impossibility of harmonizing such 
a dogma with the facts which by that time were well 
established, is too plainly evident to warrant further 
discussion in these pages. 

Discovery of Valves in the Larger Veins hy Fahricius 
ah Acquapendente. — The discovery of the presence of 
valves in the interior of the larger veins is credited by some 
to Cannani (1546) and by others to Fabricius ab Acqua- 
pendente (1574), but the best authorities appear to favor 
the claim of Fabricius to this honor. There are also a few 
authorities who maintain that Fra Sarpi, the celebrated 
monk and scientist of Venice, is entitled to be considered 
the discoverer of the valves in veins, but Tiraboschi, the 
historian of Italian literature, makes it clear that this 
claim is unfounded. 

Although it was known to Fabricius that these valves are 
inclined toward the heart, he does not appear to have 
appreciated the fact that this arrangement is entirely 
incompatible with Galen's doctrine that the flow of venous 
blood is from the liver toward the extremities ; nor did any 
other anatomist, so far as I am able to learn, discover this 



CIRCULATION OF TEE BLOOD 379 

incompatibility before it was pointed out by Harvey nearly 
fifty years later. 

William Harvey, Who is Universally Acknowledged to 
he the Real Discoverer of the Circulation of the Blood. — 
William Harvey was born at Folkstone, England, in 1578, 
received his academic education at Cains College, Cam- 
bridge, and became a doctor of medicine in 1602, at the age 
of twenty-four. Four or five years before this event he 
went to ^ Padua, Italy, to study medicine under Fabricius 
ab Acquapendente, who was considered at that period to 
be the ablest and most inspiring teacher of anatomy and 
physiology in Europe. It was from him, it may safely be 
assumed, that Harvey learned the importance of studying 
Nature herself, rather than books, when one is desirous of 
learning her secrets. Equipped with a thorough knowledge 
of the methods that may best be employed in making studies 
of this character, Harvey returned to England at the end 
of his long stay at Padua. He was soon afterward made 
a member of the College of Physicians of London, and in 
1615 was elected to the Chair of Anatomy and Surgery in 
that institution. Later still, he was appointed one of the 
physicians of St. Bartholomew's Hospital. He also held 
for several years the position of Court Physician, first to 
James the First and then to Charles the First. It was 
during this period of his professional career that he began 
working in earnest upon the problem of the circulation of 
the blood, and he kept steadily at this work throughout a 
period of several years. Among the manuscripts preserved 
in the British Museum there is one bearing the date of 1616 
which shows that Harvey had already at this time reached 
conclusions which, in all essential respects, agree with those 
which appear in his final treatise published in 1628. The 
title of the latter work is, ^^Exercitatio anatomica de motu 
cordis et sanguinis in animalibus^^ (Frankfort, 1628). 

Although, as I have shown above, several of the links in 
the chain of proofs bearing upon this question of the 
circulation had already been discovered before Harvey 
began his researches, he was not willing to accept them 
as proven facts until he had himself tested them thor- 



380 GROWTH OF MEDICINE 

OTighly by the experimental method. Furthermore, they 
were often disconnected, and this lack of continuity obliged 
him to supply missing links at several points; in other 
words, nobody had as yet demonstrated the important fact 
that the blood travels regularly in an unbroken circuit, and 
it was to this great task that Harvey devoted himself at 
the period which we are now considering. He carried out 
all these investigations with the most painstaking care and 
made public announcement of his discoveries only after 
the lapse of an extraordinary length of time; his chief 
object being that ample opportunity might thereby be 
afforded for complete verification. The following are 
among the more important questions which he investigated 
and to which he furnished satisfactory solutions. He 
learned, for example, that the auricle and ventricle of each 
side of the heart do not contract simultaneously but in 
succession. When the right auricle contracts the blood 
which it then contains passes into the right ventricle ; and 
when the right ventricle contracts the blood is driven into 
the pulmonary artery. From this vessel it passes ulti- 
mately into the pulmonary vein, and from the latter into 
the left auricle, which then contracts and drives the blood 
into the left ventricle. The latter chamber next contracts 
and forces the blood into the aorta, whence it is carried 
into all the arteries of the body. From these, in turn, it 
passes into the veins and thence back to the right auricle 
of the heart — the point from which it started. He corrobo- 
rated the finding — ^by other anatomists who had preceded 
him — of membranous valves at the spots where the blood 
passes from one chamber to the other; and he compared 
these valves to little doors which open to permit the passage 
of the blood in one direction, but which close when there 
is any tendency for it to pass in the opposite direction. 
The valves of the right auricle, for example, allow the 
blood to pass into the right ventricle, but prevent it from 
returning into the auricle. Then, further, the valves of 
the right ventricle permit the blood to pass into the 
pulmonary artery, but prevent it from returning into the 
ventricle. The valves of the left auricle permit the blood 



5arfl 




FIG. 15. WILLIAM HARVEY. 
(After the portrait by Cornelius Jonson.) 



CIRCULATION OF TEE BLOOD 331 

to pass into the left ventricle, but do not permit it to return 
into the left auricle. Finally, the valves of the left ventricle 
allow the blood to pass into the aorta, but prevent it from 
regurgitating into the same ventricle. The valves with 
which the veins are equipped permit the blood to travel 
onward toward the heart, but do not permit it to back up 
into the arteries. 

Galen taught that the arteries pulsated by reason of a 
"pulsific^ power" which they derive in direct continuity 
from the tunics of the heart. He tried to prove the correct- 
ness of his doctrine by experimental methods, but in this 
he failed. Harvey was convinced that the arteries do not 
pulsate by reason of their own inherent power, but by a 
force of impulsion communicated to the blood at the heart. 
He refers to this question in the following terms: ''When 
an artery is opened the blood escapes in jets of unequal 
force; the alternate jets being stronger than the inter- 
mediate, and the stronger jets corresponding in time of 
occurrence, not with the systoles but with the diastoles of 
the artery. The artery, therefore, must be distended by 
impulsion, by the shock of the blood. If the artery dilates 
by reason of its own inherent power, the blood would not 
be expelled with the maximum force at the very moment 
when this dilatation occurs." As evidence of the non- 
existence of Galen's assumed ''pulsific power," Harvey 
mentions the fact that, in the case of a patch-shaped 
calcification of the crural artery which came under his 
observation, the pulsation took place as usual, but at a 
point below (distal to) the edge of the patch. The inter- 
vening patch of rigid calcareous matter was not able to 
prevent the traveling onward of the propelling power. 

Harvey next takes up the consideration of the veins, and, 
after showing that they permit a flow of the contained 
blood in only one direction, — ^viz., that from the extremities 
toward the heart, — he calls attention to certain experiences 
which he has had: (1) When a cord is tied lightly around 
a limb the flow of blood is arrested only in the veins, because 
these vessels are located near the surface of the skin; but, 
if the cord is tied more tightly, the flow of blood is also 



382 GROWTH OF MEDICINE 

arrested in the arteries, which lie at a relatively great 
depth. (2) When a vein is tied the resulting distension 
manifests itself only below {i.e., on the distal side of) the 
ligature; whereas, when an artery is similarly tied, the 
distension takes place above {i.e., on the proximal side of) 
the ligature. It is therefore plain that in the veins the 
blood flows from the individual parts toward the heart, but 
that in the arteries the flow is in the reverse direction — i.e., 
from the heart toward the individual parts. ''If one 
reflects upon the nature of the movement of the blood," 
says Flourens, ''one will promptly realize how speedy it 
is. Scarcely has the blood entered the heart before it is 
hurried into the arteries; and then from these vessels it 
passes in an instant into the veins, from which, with almost 
equal speed, it finally travels back to the heart again. It 
is this never-ending movement from one channel into 
another, and then eventually back to the starting-point, 

which constitutes the circulation of the blood 

Modern physiology dates from the discovery of the circu- 
lation of the blood. Up to the time of this discovery 
physiologists followed the ancients; they did not dare to 
walk alone. Harvey had discovered the most beautiful 

phenomenon in the animal economy From this 

time forward, instead of swearing by Galen and by Aris- 
totle, one had to swear by Harvey ! ' ' 

Despite the great care which Harvey took to back up his 
scheme of the circulation of the blood with unimpeachable 
proofs of its correctness, he was obliged to pass through 
the same sort of experience as that to which Vesalius and 
scores of other pioneers in the field of scientific inquiry had 
been subjected. Two hostile forces stood constantly ready, 
during that fruitful period of the Eenaissance, to attack 
with merciless bitterness all those who ventured to add new 
facts to our stock of knowledge in the domain of medicine. 
On the one side were the many men of small calibre, men 
filled with jealousy over the successes gained by co-workers 
in the same field ; and on the other was marshaled the host 
of those who honestly believed that all medical msdom 
ended with Galen. Before his death, however (hardly 



CIRCULATION OF TEE BLOOD 383 

thirty years later), Harvey had the satisfaction of witness- 
ing the almost unanimous acceptance of his dogma con- 
cerning the circulation of the blood. Louis the Fourteenth, 
King of France at this period, was so appreciative of the 
importance of Harvey's discoveries that he appointed 
Dionis, the distinguished French anatomist, to demonstrate 
to the students of the Medical School of the Jardin des 
Plantes at Paris the circulation of the blood and other 
recent discoveries. Descartes (1596-1650), the celebrated 
French philosopher, paid an even greater compliment to 
the high character of the work- accomplished by Harvey. 
His words, as quoted by Flourens, are as follows : — 

If I am asked why the supply of venous blood does not become 
exhausted in flowing thus unceasingly into the heart, and why 
the arteries — since all the blood that passes through the heart must 
travel along these vessels — do not become filled to overflowing, I 
can see no good reason why I should not give to this question the 
very same answer that William Harvey, an English physician, 
to whom praise is due for having taught , . . . , has already given. 
[Then follows the text of Harvey's reply.] 

Our readers have doubtless noted the fact that, while 
Harvey, as I have endeavored to show in the preceding 
account, has clearly established his right to be considered 
the discoverer of the circulation of the blood in all its most 
essential features, his scheme fails to furnish any infor- 
mation concerning the composition of the blood and the 
manner in which it is built up into a life-giving fluid. In 
the minds of some this may seem to be an omission. A 
moment's reflection, however, will satisfy any reasonable 
person that questions of this nature do not form a legiti- 
mate part of the problem which Harvey was engaged in 
solving, and that they therefore should receive separate 
consideration. Thus, for example, Harvey's scheme fails 
to furnish satisfactory information concerning those por- 
tions of the circuit where the blood is obliged to travel 
through a system of communicating capillary channels, as 
happens in the lungs and in the tissues generally through- 
out the body. But Harvey had no means at his command 



384 GROWTH OF MEDICINE 

for investigating a question of this nature. Capillary- 
blood-vessels are invisible to the naked eye, and may be 
studied only with the aid of a microscope; but this 
instrument was not available until long after the time 
(1605-1616) when Harvey was engaged in carrying out his 
investigations into the circulation of the blood. 

Other Discoveries Relating to the Vascular System. — To 
Vesalius is due the credit of having discovered the fact that 
anastomoses exist between the carotids and the vertebral 
arteries, thus explaining how a man may continue to live 
even after both carotids have been severed or ligated. His 
great rival, Fallopius, described these anastomoses in the 
most detailed manner, and he noted the further fact that 
an anastomosis with the basilar artery exists. 

By the end of the sixteenth century a certain amount of 
progress had been made toward a correct knowledge of the 
lymphatics. Bartholomaeus Eustachius, for example, dis- 
covered the existence (in horses) of the thoracic duct, but 
he supposed it to be a vein. His description of this vessel 
reads as follows : — 

In these animals there is a large vessel which extends downward 
from the inner aspect of the clavicular vein ( = left subclavian 
vein). At the point where it joins the vein it is closed by means 
of a semicircular valve. This vessel is of a whitish color and it 
contains a scanty watery fluid. Not far from its starting-point it 
divides into two branches which very soon, however, join together 
again, and then, as a single trunk from which no further branches 
are given off, it passes down along the left side of the spinal column, 
penetrates the diaphragm, spreads itself out over the aorta, and 
ends in a manner unknown to me. 

About one hundred years later (1647), Jean Pecquet of 
Dieppe, France, professor in the Medical School of Mont- 
pellier, rediscovered (in a dog) this same duct, with its 
tributary chyle ducts and also its point of entrance into 
the left subclavian vein ; and, as he had rightly interpreted 
its nature, anatomists by common agreement accorded him 
the rights of discoverer. 



CIRCULATION OF THE BLOOD 385 

At a still earlier date (1622) Caspar Aselli of Cremona, 
Northern Italy, professor in the Medical School of Pavia, 
discovered the chyle ducts. This discovery was made under 
the following circumstances, which reveal the fact that 
good luck sometimes plays an important part in the work 
of the searcher after truth in the departments of anatomy 
and physiology: — 

Aselli was studying the distributiomof the recurrent nerves and 
the movements of the diaphragm in a well-nourished living dog, 
when his attention was drawn to the presence of a large number 
of delicate white threads coursing as it were over the surface of 
the mesentery. Following the accidental injuring of one of these 
threads there escaped from the wounded structure quite a large 
quantity of chyle. Aselli, who instantly appreciated the full sig- 
nificance of what had happened, exclaimed, in the presence of the 
bystanders, ''Eureka!" At the time he supposed that these chyle 
vessels terminated in the liver and contributed in some manner 
to the elaboration of the blood (in harmony with Galen's univer- 
sally accepted theory of sanguification) ; but later, after he had 
carried out a carefully conducted series, of experiments, he was 
able to rectify this erroneous belief. (Haeser.) 

Galen's theory of sanguification may be stated as follows : 
The chyle is received into the veins of the intestinal wall 
and carried thence to the liver, in which organ they are all 
gathered together into a single venous trunk which has 
received the name of ^'vena portae^' — the vein of the gate- 
way. Everything that is destined to enter the liver passes 
through this portal vein. In the organ itself the chyle 
undergoes certain modifications, the result of which is, first, 
to deprive it of its impurities and then, in addition, to effect 
other changes that convert it into blood. Aselli 's glory, 
then, consists in his having shown that chyle is taken up 
from the intestinal mucous membrane by a set of its own 
vessels, and not by the veins, as taught by Galen. 

In 1651 Olaus Rudbeck of Arosen, Sweden, discovered 
the lymphatics of the intestinal canal and followed their 
distribution into the lymph nodes ; he also established their 
relations with the thoracic duct and with the venous system. 

Thus, thanks to the series of brilliant discoveries made 



386 GROWTH OF MEDICINE 

by William Harvey, Realdus Columbus, Fabricius ab 
Acquapendente, Pecquet, Aselli and a few others, the 
doctrine of the circulation of the blood and of the part 
played by the accessory chyle and lymphatic vascular 
systems, became firmly established before the end of the 
seventeenth century. 



CHAPTER XXX 

ADVANCES MADE IN iNTERNAL MEDICINE AND 
IN THE COLLATERAL BRANCHES OF BOTANY, 
PHARMACOLOGY, CHEMISTRY AND PATHO- 
LOGICAL ANATOMY 

General Remarks. — In the fundamental branches of 
medical knowledge — anatomy and physiology — advances 
of a very decided character were accomplished during the 
sixteenth and seventeenth centuries; and in the preceding 
chapters I have endeavored to give my readers some idea 
of the nature of these advances, of the men who were 
instrumental in effecting them, and of the extent to which 
the way was made easy, during this period, for the accom- 
plishment of still further advances. In carrying on the 
work of correcting the many errors which were found to 
exist in the two departments mentioned, it was. soon dis- 
covered that the obstacles to be overcome were oiP a serious 
character, and that the most formidable one of the group 
was what is universally known as Galenism. If I now 
refer to this subject once more, perhaps for the second or 
third time in the course of this history, it is because I 
fear that my remarks with regard to the harmful influence 
exerted by Galenism may not be rightly interpreted. For 
Galen's personal character I entertain, as I have already 
stated in the section relating to Ancient and Mediaeval 
Medicine, the deepest respect, and I am filled with great 
admiration for what he accomplished in advancing the 
science of medicine ; but at the same time I cannot overlook 
the fact that he was hemmed in by insurmountable limita- 
tions. No single human being, living at the beginning of 
the present era and surrounded, as Galen was, by a herd of 



388 GROWTH OF MEDICINE 

jealous rivals, could have successfully bid defiance to those 
who considered it sacrilegious to dissect the dead body of a 
fellow man ; and yet, without the knowledge which may only 
in this way be gained, how was it practicable for any 
individual, no matter how clever he might be, to lay the 
foundations for a further advance in medical knowledge? 
It seems to me therefore plain that Galen did all that lay 
in his power to advance the science of medicine; and 
whatever words of condemnation I may have employed 
in the text, when speaking of the Galenists, refer solely to 
those physicians of later centuries who were of such a 
narrow-minded type, so rigidly crystallized in the belief 
that Galen's teachings had reached the limit of all possible 
knowledge in the science of medicine, that they did not 
hesitate to class the efforts of men like Vesalius as acts of 
unpardonable impiety. Galenism, then, refers to the very 
widely prevalent tendency among physicians of the fifteenth, 
sixteenth and seventeenth centuries to uphold the teachings 
of Galen as the only trustworthy code upon which they 
should depend for their guidance. In short, Galenism, at 
the period named, meant for medicine a complete arrest of 
development. 

I have now arrived at a point in the history of medicine 
where, owing to the limited amount of space at my com- 
mand, the difficulty of deciding as to what subjects and 
what individual workers in the field of medicine — a field 
now grown to very great proportions — shall receive con- 
sideration in my sketch. Having decided from the very 
outset that my best efforts shall be directed, consistently 
with a strict adherence to historical truth, toward making 
my account readable, I now find it absolutely necessary 
to jettison — ^if I may be permitted to use such a nautical 
expression — much really valuable cargo, and to put ashore, 
before continuing our voyage, many passengers of un- 
doubted worth. Nobody need bemoan the loss of all these 
valuable treasures, for the great majority of them, I am 
confident, will be cared for properly by those authors who 
are privileged to treat this whole subject with some degree 
of thoroughness; and the reader, if he is familiar with 



ADVANCES IN INTERNAL MEDICINE 389 

German, will even now find, in the excellent general 
treatises of Haeser, von Gurlt, Pagel, Pnschmann, Baas- 
Henderson and Neuburger, great stores of the most satis- 
factory information concerning the thousand and one 
details about which I am obliged to remain silent. 

Internal Pathology. — During the fifteenth century the 
practitioners of medicine in Italy and France were still 
strongly under the influence of the teachings of the Arabian 
medical authors. One of the first writers in Italy to place 
the doctrines of internal medicine upon a firmer footing 
was Antonius Benevienus, a native of Florence (1440-1502). 
His treatise on some of the unusual causes of disease, which 
was printed in Florence in 1506, is said to be written in very 
clear language and to be based entirely upon cases which 
came under his own observation. According to Haeser 
the first improvements in the doctrines relating to patho- 
logical anatomy may be credited to Benevienus, who also 
taught that pathological phenomena should be studied by 
direct observation rather than from books. 

Johannes Manardus of Ferrara (1462-1536) was a very 
sturdy opponent of astrology, and, in general, did all in 
his power to weaken the prevailing blind trust in the 
authority of the Arabian medical authors. But the two 
physicians who, next to Fabricius ab Acquapendente, stand 
out most conspicuously among their Italian contemporaries 
of the sixteenth and seventeenth centuries, are Fracastoro 
and Lancisi — the former a native of Northern and the latter 
of Southern Italy. 

Hieronymus Fracastoro of Verona (1483-1553) ranks 
very high among the physicians of the first half of the 
sixteenth century for his valuable contributions to our 
knowledge of internal pathology. In the treatise which he 
published in 1546 on contagious maladies, he states in plain 
language his belief that the causes of diseases of this 
nature are to be found in living germs that are endowed 
with the power of propagating themselves. He divides 
these diseases into the following three groups : — 

1, Those which infect only by contact; 2, Those which not only 
infect by contact, but at the same time leave behind a centre or 



390 GROWTH OF MEDICINE 

focus of infection — in which category he places tuberculosis, 
elephantiasis, and similar diseases; and 3, Those which infect not 
only by direct contact, or through the agency of a residuary centre 
or focus of infection, but also those which are capable of spreading 
their infective elements over wide areas — for instance, the pesti- 
lential fevers, certain ophthalmias, variola, etc. (From Viktor 
Fossel's version of Fracastoro's treatise published in Leipzig in 
1910.) 

Speaking of tuberculosis (called by him '* phthisis"), 
Fracastoro says that it is astonishing for how great a 
length of time the virus of this disease retains its infective 
power. ''It has been noted, for example, that in quite a 
number of instances the clothes worn by a tuberculous 
patient have communicated the disease to a healthy indi- 
vidual as late as two years subsequently to the date at 
which they were removed from the original tuberculous 
individual. ' ' The same power of communicating infection, 
he continues, may reside in such other objects as the bed, 
the walls and the floor of the room in which a tuberculosis 
patient has died. Under these circumstances, he adds, we 
are obliged to assume that germs of this infective disease 
have remained attached to the different objects mentioned. 

Fracastoro was born in Verona, Italy, of parents who 
belonged to the patrician class and were in easy circum- 
stances. He studied mathematics and philosophy at the 
University of Padua, and was quite prepared, on reaching 
the age of twenty, to pass the examinations required of 
candidates for the degree of Doctor of Medicine. Just at 
this time, however, Padua was not a safe place of residence, 
owing to the war that was threatened between the Emperor 
Maximilian the First and the Republic of Venice. Accord- 
ingly Fracastoro took his degree at the newly established 
Academy of Pordenone, in what is known to-day as the 
Province of Udine (northeast of Venice) ; and shortly 
afterward, upon the death of his father, he returned to 
Verona and began the practice of medicine. As he quickly 
gained the confidence of the people, he very soon found 
himself in a sufficiently prosperous condition to warrant 
him in retaining possession of the family residence, which 



ADVANCES IN INTERNAL MEDICINE 391 

was charmingly located at the foot of Monte Incaffi, midway 
between the Adige River and the Lake of Garda. Here 
it was that Fracastoro did a large part of his literary 
work, for he was a poet as well as a physician. Pope Paul 
the Third appointed him to the position of Physician -in- 
Ordinary to the Council of Trent, and it was by his advice 
that, upon the appearance of the Plague in that city, the 
sittings of the Council were thereafter held for a short 
season at Bologna. Later, still other honors fell to his lot. 
He enjoyed the esteem of the Emperor Charles the Fifth 
and of Francis the First, King of France; and the latter 's 
highly cultivated sister, Margaret of Navarre, offered him 
every inducement to settle at her Court, but the attractions 
of his own home made it easy for him to decline all these 
offers. He died at his villa on August 6, 1553, and six years 
later the city of Verona erected in his honor a marble 
memorial tablet. 

Fossel, in his biographical sketch of Fracastoro, says 
that the most popular of his poetical writings was that 
entitled, ^^ Syphilis sive morbus Gallicus.^^ It was pub- 
lished in several successive editions, and was translated 
into nearly all the languages of European countries. I 
shall have occasion to refer to it again in a later chapter. 

Giovanni Maria Lancisi was born at Eome on October 26, 
1654. Like Boerhaave he began his university studies 
under the service of the Church, but, as time went on, his 
leaning toward the profession of medicine became more 
and more pronounced, and he soon took up in earnest the 
study of that science at the University of Sapienza, 
devoting a large share of his time to dissecting and to 
clinical work in the hospitals. In 1672, when he was only 
eighteen years old, he was given the degree of Doctor of 
Medicine ; and four years later, after a competitive exami- 
nation, he was appointed an assistant at the Hospital of 
the Holy Ghost. In 1678 he was permitted, as a special 
honor, to enrol himself as a student in the College de Saint- 
Sauveur. During the following five years he enjoyed at 
this institution exceptional facilities for studying medical 
literature, and was thus able to accumulate an immense 



392 GROWTH OF MEDICINE 

mass of useful extracts from the writings of the best 
authors. In 1684 he was assigned to the duty of teaching 
anatomy at the Sapienza, and for thirteen years he filled 
this post with great credit to himself ; Malpighi being one 
of those who took pleasure in following his lectures. He 
had scarcely attained his thirtieth year when he was 
honored by being appointed Physician-in-Chief and Privy 
Councilor to Pope Innocent the Eleventh; and soon after- 
ward he was made a Canon of the Church of Saint Law- 
rence, the main purpose of which appointment was to 
provide him with a suitable income. On the death of the 
Pope in 1689 he resigned the latter office, in order that he 
might have more leisure and freedom to pursue his profes- 
sional duties. Subsequently he became the regular medical 
attendant, first of Pope Innocent the Twelfth and afterward 
of Pope Clement the Eleventh. He died on January 21, 
1720. 

Von Haller speaks of Lancisi as *'a physician who was 
most highly esteemed by Pope Clement the Eleventh, who 
was very learned and very philanthropic, and who loved 
to give aid to the afflicted and to prevent litigation by wise 
counsels." It was Lancisi also, as I have stated on a 
previous page, who discovered at Rome, in the possession 
of the heirs of the artist Pini who made the original draw- 
ings, the copper plates which Eustachius had ordered nearly 
two hundred years earlier, and which were to have been 
used by this celebrated anatomist in the production of a 
most beautiful set of anatomical illustrations.^ 

The two most important original treatises published by 
Lancisi bear the following titles: *'Z)e motu cordis et 
aneurysmatihus^^ (on the movements of the heart and on 
aneurysms), Rome, 1728 (a later edition in 1745); and 
**Z)e suhitaneis mortibus Lihri IP^ (on sudden deaths), 
Rome, 1707 (also later editions). 

Botany and Botanical Gardens. — The Egyptians, the 
Persians, the inhabitants of India and China, and the 
ancient Greeks accumulated a great mass of information 

1 An edition of the completed set of these plates was published hj Lancisi 
at Borne in 1714. 



ADVANCES IN INTERNAL MEDICINE 393 

relating to plants which might be utilized in the treatment 
of different diseases. Then, in the early part of the present 
era, Galen contributed not a little to our further knowledge 
on this subject; but from that time forward, until the six- 
teenth century, pharmacology practically remained un- 
changed. The beginnings of a systematic study of all 
plants — in other words, modern botany — may be traced to 
the establishment of botanical gardens, first in Italy and 
afterward in Holland and France.- According to Berendes 
the very earliest attempt in relatively modern times 
to cultivate such a garden was made at Salerno by 
Matthaeus Silvaticus. Then Master Gualterus, in 1333, 
was permitted by the Governing Council of Venice to make 
use of a certain plot of ground for the cultivation of the 
plants in which he was specially interested. So far as one 
may judge, however, both of these were private under- 
takings. In 1545, at the request of Francesco Buonafrede, 
Professor of Therapeutics at the University of Padua, the 
Senate of that city laid out a garden for his uses in teaching. 
This appears to be the earliest instance of the establishment 
of a botanical garden in connection with a regularly 
organized medical school. Then, in fairly quick succession, 
similar gardens were established at Pisa (1547), Bologna 
(1567), Leyden, Holland (by Boerhaave in 1577), and 
Heidelberg (1593). In France the University of Mont- 
pellier received its first botanical garden in the year last 
named. Thus it appears that about the middle of the 
sixteenth century botany began to receive attention as a 
branch of knowledge which, as was then believed, it was 
important for physicians to study; and from that time 
forward, for more than two centuries, it formed a regular 
part of the curriculum in all the leading medical schools. 
The two chairs of botany and anatomy were not infre- 
quently combined. Fallopius, for example, held the Chair 
of Anatomy, Surgery and Botany in the University of 
Padua, and so also did Vesling in the same university at a 
somewhat later date. The first systematic works on botany 
were also published in the sixteenth century. They were 
all written by German or Swiss authors, the most note- 



394 GROWTH OF MEDICINE 

worthy one of the collection being that of Conrad Gesner 
of Ziirich (1516-1565), who is spoken of by Haeser as ''a 
man of noble birth, of extraordinary industry, of extensive 
knowledge in every department of natural history, and the 
author of a large number of treatises, which, by reason of 
their intrinsic value, cannot fail to perpetuate the memory 
of this distinguished scientist throughout all time." He 
had much to contend with throughout his short but eventful 
life. In the first place, he was very poor — so poor that both 
he and his young wife were obliged to support themselves 
during the early years of their married life by teaching 
school. Then he studied medicine at Basel, and afterward 
accepted the professorship of Greek, first at Lausanne and 
then in turn at Basel and at Ziirich. From the beginning 
to the end of his career he was hampered by poverty and 
by frequent illnesses. But, despite these obstacles and also 
notwithstanding the fact that he was an indefatigable 
worker in matters relating to natural history, he is reported 
to have played one of the most influential parts in the drama 
of the Reformation. Only a man of exceptionally strong 
character and of unusual ability would have found it 
possible to attain the success which Gesner attained in these 
different undertakings and under such unfavorable circum- 
stances. Andreas Caesalpinus, whom I have already men- 
tioned as one of the earliest investigators of the question 
of the circulation of the blood, also interested himself in 
the science of botany. Puschmann speaks of him as the 
greatest botanist of the sixteenth century. For several 
years he was Professor of Philosophy and Medicine in the 
University of Pisa, but at a later date Pope Clement the 
Eighth chose him to be his private physician and also 
appointed him Professor of Medicine in the University of 
Sapienza at Rome. His death occurred in the latter city 
in 1603. 

Before dismissing all further consideration of the part 
played by Italian and Spanish physicians during the six- 
teenth century in the advancement of the science of medi- 
cine, I shall briefly mention a few additional discoveries in 
botany and pharmacy that may serve to render the present 



ADVANCES IN INTERNAL MEDICINE 395 

account more complete. In 1518 the monk Romano Pane 
published the first account of the discovery of tobacco in 
America. In 1560 Jean Nicot, a French diplomatist, brought 
back with him from Portugal (to which country he had 
been sent as an ambassador) a small supply of the seeds 
of the plant. To commemorate this service the alkaloid 
found in the leaves of the tobacco plant was given the name 
of nicotine. Capsicum was made known to the world by 
Dr. Chanca, a companion of Christopher Columbus on the 
occasion of his second voyage (1493) to America. Balsam 
of Copaiva was discovered by a Portuguese monk in Brazil 
at some time between the years 1570 and 1600. It is men- 
tioned for the first time in the Amsterdam Pharmacopoeia 
of 1636. Monardes described the Peruvian and Tolu 
balsams in 1565. Cacao was first made known to Europeans 
by Fernando Cortez in 1519. About the year 1550 coca was 
introduced as a drug that possesses the power of allaying 
hunger and of enabling one to endure the fatigues attending 
prolonged expeditions. Sarsaparilla came into use at 
about the same date. Then followed jalap in 1556 and 
sassafras toward the end of the century. 

In Germany and in the Netherlands there were, during 
the sixteenth century, very few physicians who manifested 
any marked degree of learning in the science of medicine. 
The teachings of Paracelsus met with a favorable reception 
in these parts of Europe and they continued to hold 
supreme sway over the minds of men during a long period 
of time. There were some physicians, however, who had 
received their early professional training in Italy and 
France, and who for this reason were less ready to accept 
unreservedly the doctrines of Paracelsus ; and, among these 
more independent spirits, Eembert Dodoens (Dodonaeus, 
1517-1586) of Malines, near Antwerp, distinguished himself 
by making a number of valuable contributions to the science 
of medicine. He held the Chair of Medicine at the Univer- 
sity of Leyden and was also the personal physician of the 
Emperors Maximilian the Second and Rudolphus the 
Second. He was a very accurate observer, and his writings 
are particularly rich in matters relating to pathological 



396 GROWTH OF MEDICINE 

anatomy; for which reason not a few authorities are 
inclined to credit him with the honor of being the founder 
of this department of medical science. Felix Platter of 
Basel, Switzerland, of whose experiences as a student at 
the University of Montpellier I have given a brief account 
on a previous page, and who was at this time Professor 
of Medicine in his native city, was also greatly interested 
in pathological anatomy. Haeser gives him credit for 
publishing a number of valuable contributions to this 
department of medical knowledge, and also for making the 
first attempt at a classification of diseases. 

Before I close this chapter it seems only fair that I 
should add a few comments upon the careers of two 
physicians whose professional attainments entitle them to 
some consideration. The men to whom I have reference are 
Marcello Donato and Eaymond Minderer. 

Marcello Donato was a distinguished medical prac- 
titioner of the city of Mantua, Northeastern Italy, who died 
about the year 1600. He was one of the few who, at that 
early period, taught that it was very important to study 
disease from nature — i.e., from direct observation — and not 
from books. His description of the epidemic of small-pox 
of 1567 (published at Mantua in 1569) is worthy of 
commendation. His chief work, however, is that which 
bears the title ^^De medica historia mirabili etc.'' (Mantua, 
1586.) It contains a remarkably large and complete collec- 
tion of rare and extraordinary cases belonging to every 
department of medicine, and in his descriptions Donato pays 
particular attention to the pathologico-anatomical aspects 
of each case. He reports, for example, the instance of a 
Caesarian section performed on a living woman in 1540 
by Christopher Bain ; the child being found dead. Another 
interesting case reported by Donato is that of a child in 
whose ear a cherry pit had been allowed to remain undis- 
turbed until it began to sprout; after which it was found 
easy to remove the impacted object. In a somewhat 
similar case which Donato also reports, the sprouting of 
the seed of Anagyris was hastened by the presence of a 
purulent discharge from the ear. In both instances all 



ADVANCES IN INTERNAL MEDICINE 397 

attempts to extract the foreign body had failed until the 
sprouting had caused the seed to split. Finally, there is 
recorded the case of a young man into whose nasal passage 
a leech had penetrated, while he was bathing, and had then 
taken up its abode far back in the canal. Donato, by aid 
of direct sunlight, ''discovered the creature in that part 
where the nasal channel merges into the oral cavity.'* 
Presumablj^ he succeeded in removing the animal, but the 
text quoted by von Gurlt (Vol. II., p. 517) furnishes no 
further particulars. 



CHAPTER XXXI 

CHEMISTRY AND EXPERIMENTAL 
PHARMACOLOGY 

The experiments which were carried out by Antonius 
Musa Brasavola, in the early part of the si:^eenth century, 
upon animals and criminals, for the purpose of learning 
the effects produced by certain drugs when administered 
internally, afford one of the earliest instances of a genuine 
experimental pharmacology. The account of these experi- 
ments, which was published at Rome, in 1536, under the 
title ^^Examen omnium simplicium, quorum usus est in 
publicis officinis,^' deserves honorable mention. An even 
more remarkable evidence of the research spirit which was 
abroad at that period is to be found in the work done by 
Fortunatus Fedelis, a native of Palermo, Sicily, and an 
ardent champion of the direct method of observation as 
applied to therapeutics. 

Van Helmont, of whose life and contributions to the 
science of medicine I now propose to furnish a sketch, 
represents in a certain sense Paracelsus' successor; and, 
as a matter of fact, he was even more closely associated 
with the development of chemistry as an independent 
science than was his predecessor. 

Jean Baptiste Van Helmont was born at Brussels in 
1577. His parents, who belonged to the nobility, possessed 
ample financial means and were therefore able to give their 
son every opportunity to secure a liberal education. While 
still a lad he enrolled himself among the students of the 
University of Louvain, and advanced so rapidly in his 
studies that, already at the early age of seventeen, he had 
passed all the examinations required of applicants for the 
degree of Master of Philosophy. He was not willing. 



CHEMISTRY AND PHARMACOLOGY 399 

however, to receive this honor at that time, feeling that he 
had not acquired suJBficient knowledge to justify such 
acceptance; and from that date forward he turned his 
attention to the study of other branches of learning. 
Finally, in 1599, he accepted from the same university the 
degree of Doctor of Medicine, and soon afterward left 
Belgium with a large party of his friends to make an 
extensive toiir through the Alps of Switzerland and Savoy. 
After his return home in 1602 he devoted his attention 
chiefly to chemical researches ; but in a very short time he 
started off again on a journey to Spain and France, and 
eventually to England, where he spent nearly a year in the 
city of London, returning to Belgium in 1605. He married, 
about this time, a rich heiress of Wilworde, in the neighbor- 
hood of Brussels, and resumed with great zest his labors in 
chemistry and alchemy. He was thus enabled to manu- 
facture many remarkable remedies with which — as he 
himself declared — he succeeded in curing myriads of 
patients who had failed to receive any benefit whatever 
from the ordinary resources of medical science. He died 
on December 30, 1644. 

I do not feel equal to the task of expounding Van Hel- 
mont's often very obscure theories regarding the physical 
and psychological processes that take place in the human 
being; regarding the distinctions which he makes between 
the ^^archaeus influus^' — the regulating principle which 
governs all the psychical and physiological processes in 
the body — and the ^^archaeus insitus^^ — the subsidiary 
power which resides in each individual part of the body, 
but which at the same time is under the control of the 
'^archaeus influus^'; and regarding the doctrine that dis- 
ease is the result of an ^'idea morbosa^' of the '^archaeus 
influus.^* August Hirsch says that in developing these 
theories Van Helmont puts forward many bright ideas, 
which unfortunately lead one into a wilderness of fantastic, 
theosophic concepts. If suflQjj^ent time and space were at 
my command it might be interesting to separate some of 
these bright thoughts from the extravagances in which they 
are buried, and thus demonstrate the truth of the state- 



400 GROWTH OF MEDICINE 

ments made by both Hirsch and Dezeimeris to the effect 
that Van Helmont, in matters relating to physiology and 
pathology, was unquestionably a precise and critical 
observer, a sound thinker, and a correct interpreter ; but 
the plan of the present work will not permit me to enter 
into all these details. I can only quote a few of the teachings 
or sayings to which Hirsch refers : — 

Digestion does not, as Galen maintains, depend upon heat, but 
upon a certain ferment existing in the gastric juice. 

Heat is not, as has hitherto been taught, the cause of life, but 
rather one of its products. 

The final cause of the sensory phenomena of life is the archaeus 
influus, which, while it is inseparably united with matter, neverthe- 
less does not represent the soul itself, but rather the organ of the 
soul, and is seated in the "duumvirate" of the spleen and the 
stomach. 

Disease, in order to acquire sufficient power to antagonize life 
effectively, must unite its forces with the archaeus influus. 

It is claimed that Van Helmont, more than any other 
teacher of medicine, was instrumental in giving the death- 
blow to the practice — which prevailed in all the medical 
schools of that day — of teaching the obsolescent Galenic 
doctrines, and that for this valuable service alone he 
deserves full recognition at the hands of the medical 
profession of to-day. But, as we learn from Ernest von 
Meyer's history of chemistry. Van Helmont has a much 
stronger claim for recognition in the fact that he made 
many important contributions to iatrochemistry and also 
to fundamental or pure chemistry. Taking one thing with 
another, says von Meyer, we may safely assert that Van 
Helmont 's useful contributions to the medical and chemical 
sciences by far outweigh those which are of a fantastic or 
useless nature. It was he, for example, who materially 
increased our knowledge of the nature of carbonic acid. 
He demonstrated how it may be extracted from limestone 
or from potash by the aid of acids, from burning coal, and 
from wine and beer while they are undergoing fermentation. 
He also showed that it is present in the stomach, in various 



CHEMISTRY AND PHARMACOLOGY 401 

mineral waters, and in hollows in the earth. He gave it 
the name of ^^gas sylvestre.''^ He would doubtless have 
carried his discoveries much farther along if he had 
possessed the apparatus which is required for such re- 
searches. However, despite the lack of these facilities, he 
was able to describe hydrogen and marsh gas as special 
varieties which do not possess the same composition as 
ordinary air. Finally, in his treatise entitled ^^Pharma- 
copolium ac dispensatorium modernum^^ will be found a 
goodly number of useful instructions as to the proper 
manner of preparing drugs. 

A complete collection of his writings was published at 
Amsterdam by his son, in 1648, under the title ^'Ortus 
medicinae vel opera et opuscula omnia.''^ 

Theophrast von Hohenheim — who is known everywhere 
throughout the world as ** Paracelsus" — was the son of 
Wilhelm Bombast von Hohenheim, a physician who 
belonged to one of the noble families of the Duchy of 
Wiirttemberg. He was born in 1493 at a spot called ^^Das 
Hohe NesV^ (the lofty nest) in the Canton of Schwyz, 
about one hour's distance from the celebrated monastery 
or cloister of Einsiedeln, of which institution his father 
was the official physician. Switzerland, therefore, has a 
right to claim Paracelsus as one of her sons. In 1502 his 
father transferred his home to Villach, in Carinthia (to 
the east of Tyrol), and continued to live there up to the 
time of his death in 1534. It is not known where the son 
obtained his degree of Doctor of Medicine. It is a well- 
established fact, however, that he received the first part 
of his training as a chemist from Johann Trietheim, the 
Prior of Sponheim, and his subsequent education in the 
laboratory of Sigmund Fugger, the cultivated owner of 
wines at Schwatz in the Tyrol. He traveled all over 
Europe, going from one university to another and making 
the acquaintance of people who were well informed in 
matters relating to natural history, chemistry and metal- 
lurgy ; and during all this time he appears to have absorbed 
a great deal of information relating to almost every 
department of human knowledge. Finally in 1526, soon 



402 GROWTH OF MEDICINE 

after he had returned to Switzerland, he received, through 
the aid of certain influential citizens, two important official 
positions in Basel, — that of City Physician and that of 
Professor of Medicine and Surgery in the University. To 
the surprise of all, and contrary to long-established custom, 
he delivered his lectures in German and not in Latin. This 
action on his part called forth bitter criticism from the 
university authorities, but at first it met with the approval 
of the students. During the following two years, however, 
he gradually became unpopular with all classes of the 
community, and was finally obliged to leave Basel. Haeser 
attributes this unpopularity to Paracelsus ' rough manners, 
to his intolerance of the opinions of his colleagues, and to 
his tirades against the apothecaries for their excessive 
charges. It is very difficult to determine how far jealousy 
was responsible for the state of affairs which I have just 
described. Cabanes, the author of an admirable biography 
of Paracelsus {Revue Scientifique, Paris, May 19, 1894), 
gives his own estimate of this remarkable man's character 
in the following terms : ' ' Poor, miserable, and persecuted 
during his lifetime, he was misunderstood even after his 
death, and was calumniated by history." Paracelsus 
evidently believed it to be his bounden duty to destroy the 
then prevailing cult of Aristotle, Galen and Avicenna as 
the great teachers in medicine ; and, filled with this idea, he 
prophesied the growth of a new science of medicine on the 
ruins of their teachings. It is stated that the students, 
after one of these excited lectures, made a bonfire and 
burned a number of copies of the works of these famous 
authors, thus showing that Paracelsus was sufficiently 
eloquent to infuse some of his own reforming spirit into 
the minds of his auditors. He made a great mistake, how- 
ever, when he attacked in a similarly violent manner the 
shortcomings of many of his contemporaries. *'The med- 
ical profession," he said, ''has become a mere money- 
making business." As a natural result of such tirades, 
Paracelsus was forced to leave Basel. He fled first to 
Colmar in Alsace and at a later date took refuge in St. Gall, 
Switzerland ; and it was while he resided in that city that 



CHEMISTRY AND PHARMACOLOGY 403 

he published three books of his ^^Paramirum.^^ Then in 
1535 he once more resumed his wandering life, in the course 
of which he visited Poland, Lithuania, lUyria, etc. On 
reaching Salzburg, in Austria, he fell ill and died on 
September 24, 1541, at the age of forty-eight. 

Paracelsus was a prolific writer. To all the treatises 
which he published he gave extravagant titles. To his 
principal work, for example, he-gave that of ^^Parami- 
rum^^ — The Surprising Marvel; to another, that of 
^^Paragranum^^ — Grain of Superior Quality; and to a 
third, that of '^Archidoxia^^ — Transcendental Science. 
He wrote treatises on syphilis, on the plague, on epidemics, 
on the diseases of grave-diggers, on ore-smelters, etc. It 
is admitted by all his critics that he devoted altogether too 
much time and thought to alchemy, demonology, necro- 
mancy, etc. Cabanes quotes Cruveilhier as saying that 
Paracelsus believed in the reality of beings of a fantastic 
nature, but attached little or no importance to them. Then ^ 
Cabanes himself adds : ' ' The thing which more than any- J 
thing else absorbed his thoughts was the irresistible desire 
to overthrow the Galenic idol and substitute for it the 
science of experience, of observation pure and simple." 
Bordes-Pages, another distinguished French physician, 
says of this extraordinary man: ''The great glory of 
Paracelsus is to be found in the facts that he cast off the 
yoke of a former epoch, more speculative than practical; 
that he summoned physicians to resume their allegiance to 
experience; and that he opened a long career for the 
alchemists, upon whom he urged the duty thenceforward 
of making new remedies the principal object of their 
researches He simplified and spiritualized thera- 
peutics." Some of Paracelsus' o^ti sayings are worth 
preserving: ''Without air all living creatures would 
perish from suffocation." "Man is the supreme animal, 
the one last created." *^Alterius non sit, qui suus esse 
potest" [He who is able to be his own master should not 
allow himself to be led blindly by another]. When he was 
accused of being coarse-grained and of deceiving the people, 
he replied: "By nature and also owing to the kind of 



404 GROWTH OF MEDICINE 

people with whom I associated in my youth I am not of a 

finely-spun texture We were not nourished with 

figs and white bread, but with cheese, milk and black 

bread — food that does not make delicate lads They 

say of me that I lead the people astray, that I am possessed 
of a devil, that I am a sorcerer, and that I am a magician. 
Whatever truth there may be in these charges, one thing 
is certain: You are all of you unworthy to unloose the 
latchets of my shoes." (From Paragranum, II., 120.) 

Oporinus, who acted for a long time as Paracelsus* 
assistant, made the following statements with regard to 
some of the methods of his former master : — 

He always kept several preparations stewing on his furnace — 
as, for example, a sublimate of oil or of arsenic, a mixture of saffron 
and iron, or his marvelous Opedeldoch. He never prescribed a 
special diet nor any hygienic measures. As a purge he gave a 
precipitate of theriaca or of mithridate, or simply the juice of 
cherries or grapes, in the form of granules (about the size of the 
droppings of mice), and he was careful always to give them in 
uneven numbers (1, 3, or 5). He was bitterly opposed to the 
polypharmacy which prevailed so widely in his day, 

Cabanes says that we probably owe to Paracelsus an 
increased knowledge of the virtues possessed by the 
different preparations of antimony, mercury and iron, and 
by salines. It was he who created the distinction between 
officinal and magistral preparations. To our list of 
pharmaceutical preparations, he added tincture of helle- 
bore, compound tincture of aloes, digestive ointment, the 
tincture of metals (''Lilium" of Paracelsus), the ''Saffron 
of Mars," etc. He was the inventor of the precious 
preparation known as "/a mumie,^' a preparation which 
was popularly believed to possess marvelous healing 
powers. Ambroise Pare, toward the end of his career, was 
greatly blamed because he did not employ this remedy, and 
he was finally compelled in self-defense to write a pamphlet 
on the subject. (The text is reprinted in Malgaigne's 
'■^Ambroise Pare/' under the title of ^'Traite de la mumie 
et de la licorne.^^) 



CHEMISTRY AND PHARMACOLOGY 405 

Adolphe Gubler of Paris credits Paracelsus with the 
distinction of having been the first physician to give an 
impetus to the movement which had for its object the 
application of chemistry to the perfection of medicinal 
preparations. He also maintains that Paracelsus should 
be looked upon as in a large degree the originator of 
specific remedies, and that he is justly entitled to the 
distinction of having been the first publicly to announce 
the ''quintessences" — that is, the active principles (vege- 
table alkaloids) — of drugs. According to this claim it is 
understood that Paracelsus taught that each drug contained 
a specially active elementary body which it was possible 
to extract as a separate substance. Acting upon this belief 
Paracelsus did not hesitate to give the preference to the 
pharmaceutical preparations known as ** tinctures" — that 
is, alcoholic extracts. Great credit is also due to Paracelsus 
for his rejection of the doctrine that guaiac is an efficient 
remedy against syphilis, and for his insistence that mercury 
is the only useful agent in curing that disease. Tartar 
emetic (potassium antimonyl tartrate) is one of the drugs 
the introduction of which into our pharmacopoeia should 
be credited to Paracelsus. 

One of the earliest references to genuine diphtheria is 
to be found in the writings of Paracelsus, who speaks of 
the disease in the following terms : — 

When this disease is located in an external wound it not infre- 
quently spreads to the muscles of the larynx ; and, vice versa, when 
a person has the disease in his throat, and at the same time happens 
to have an external wound, the malady is likely to spread to the 
wound. 

Paracelsus* idea of the existence of an ''archaeus,^' a 
power which presides over all physiological actions as well 
as over all the operations of medicinal drugs, resembles 
very closely the ** vital force," or '* animism" so strongly 
championed by Stahl in the seventeenth century. 

From all that I have said above regarding the excitable 
nature of Paracelsus it seems almost a waste of time to 
tell our readers that his contributions to the science of 



406 GROWTH OF MEDICINE 

surgery were of very slight value. He despised the study 
of anatomy, claiming that a knowledge of this branch of 
medical science was not essential to a proper acquaintance 
with the human body. *'To dissect," he once remarked, 
"was a peasant's manner of procedure." (Cabanes.) His 
surgery, as one may imagine, showed clearly the bad effects 
of such beliefs. 

During the latter part of the nineteenth century there 
developed among the leading men of the medical profession 
a sentiment in favor of honoring the memory of Paracelsus 
by the erection of a suitable monument at Basel, Switzer- 
land, the city in which he made his first public appearance. 
The project met with a favorable reception and the statue 
is now an accomplished fact. This is a remarkable instance 
of tardy justice being rendered to the memory of a physi- 
cian who, for three hundred years, was almost universally 
looked upon as a vain, half -crazy man. 

The next advances of any special importance in the 
department of chemistry were made in Great Britain by 
Robert Boyle, who was born at Lismore, County of Cork, 
Ireland, on January 25, 1626. He was the fourteenth child 
of the Earl of Cork. His early training was obtained at 
Eton, and then afterward he spent two years at Geneva, 
Switzerland, in prosecuting his scientific studies. In 1654 
he entered Oxford University and became intimately 
acquainted with some of the most learned men of that day. 
While he was a student at the university he became a 
member of what was known as ''The Invisible College," 
a society which was influential in bringing about the 
founding of "The Eoyal Society," of which organization 
he was president from the year 1680 to the time of his 
death in 1691. 

Boyle was endowed with a noble character — ^modest, 
religious and generous. He gained distinction as a chemist 
in several departments. Applied chemistry is indebted to 
him for a number of important contributions ; he added to 
our knowledge of chemical combinations and to the methods 
of analyzing them; he enriched the chemistry of gases and 
also pharmacology; and he gave a clear and easily intelli- 



CHEMISTRY AND PHARMACOLOGY 407 

gible definition of what a ''chemical element" is. He laid 
stress upon the doctrine that a chemical combination 
represents the union of two component elements, and that 
this combination possesses characteristics quite different 
from those possessed by either of the two component 
elements. Before his day there was practically no such 
thing as analytical chemistry, and it is to Boyle that we 
owe the establishment of a clear conception of what the 
terms ''chemical reaction" and "chemical, analysis" 
signify. The part played by atmospheric air in combustion 
was made by him the subject of numerous experiments 
which proved later to be of great assistance in the final 
solution of the problem. 

In one of his writings Boyle says in substance that if 
men would devote their energies to carrying out experi- 
ments and collecting observations, rather than to the 
constructing of theories without having previously tested 
with thoroughness the grounds upon which they believe 
them to be based, the world would be greatly the gainer. 
The promulgation and insistence upon the importance of 
this doctrine for the growth of the science of chemistry 
constitute — so those competent to judge claim — Boyle's 
greatest merit in scientific work and his most important 
contribution to chemistry. 

Among the chemical treatises which Boyle wrote and 
published the following deserve to receive special mention: 
"Sceptical Chymist," 1661; '^Tentamina quaedam physio- 
logical^ 1661; ^^Experimenta et consider ationes de colori- 
hus,'' 1663; and "Medical Experiments," 1692-1698. 
Although Boyle was not an avowed follower of Bacon, he 
carried out thoroughly the principles which the latter 
taught. 

Raymond Minderer, a practicing physician in Augsburg, 
Germany (1570-1621), deserves the credit of having added 
to our stock of remedies the acetate of ammonia {liquor 
ammonii acetatis). Diluted with an equal quantity of 
water it is still employed to-day as a remedy under the 
name of "Spirit of Mindererus." He was the compiler, 
in 1613, of the Augsburg Pharmacopoeia. 



408 GROWTH OF MEDICINE 

General Therapeutics. — Transfusion.^The Discovery of 
Cinchona and Ipecacuanha. — In the department of general 
therapeutics, as we learn from Berendes, several important 
new measures were brought forward during the seventeenth 
century; and among these the following deserve to receive 
brief mention in this place: the operation of transfusing 
blood from a healthy individual to one who is ill; the 
introduction of cinchona into the European pharmacopoeia 
as an efficient remedy in the treatment of certain fevers; 
the similar introduction of another South American drug — 
viz., ipecacuanha; and the invention of many medico- 
chemical products and the improvement of others that 
were already in common use. 

As regards the operation of transfusion, from which 
great things were expected, Sir Christopher Wren (1632- 
1723), the famous architect and astronomer of London, is 
reported to have been the first person to urge a trial of 
this procedure. On the other hand, Robert Boyle, the 
chemist, actually performed the operation on animals. He 
followed the method suggested by Richard Lower (1631- 
1691) of England, viz., by allowing the blood to flow from 
the carotid artery of one animal into the jugular vein of a 
second animal; while Edmund King adopted the plan of 
allowing the blood to pass from the jugular vein of one 
animal into the corresponding vein of a second animal. 
Upon a human being the operation was probably performed 
for the first time (in 1666) by Denys, Professor of Phi- 
losophy and Mathematics in Paris. Repetitions of the 
operation were made, two or three years later, in London 
and in Rome, but they produced no good effects and in some 
instances they terminated in the death of the individual 
for whose benefit the operation had been performed. In 
1668 the French Parliament and the Papal Government 
forbade a repetition of the operation. 

In 1638 — so the story runs — the wife of Count Cinchon, 
Viceroy of Peru, was cured of a stubborn intermittent fever 
by the native physicians, who employed, in their treatment 
of the malady, the bark of the tree now universally known 
by the name of ** Cinchona." In 1640 Juan del Vego, the 



CHEMISTRY AND PHARMACOLOGY 409 

regular medical attendant of Count Cinchon, introduced 
the new remedy into Spain, but it was not until after the 
lapse of about fourteen years that the drug found its way 
into England and Central Europe. The price at which it 
could be purchased was at first very high; it was almost 
literally ''worth its weight in gold." Even as late as 1680 
the bark sold in England for £8 sterling per pound. Not- 
withstanding the generally recognized value of the drug 
in the treatment of certain fevers there were not a few men 
who continued for many years to oppose its use. Thus, 
Johann Kanold, a practitioner of medicine in Breslau, 
Germany, is reported to have said, on his deathbed in 1729, 
that he would rather die than be cured by a remedy the 
action of which was so opposed to all the principles which 
he considered right in therapeutics. 

Ipecacuanha, another very important drug, was added 
to our stock of remedial agents toward the end of the 
seventeenth century. It was brought into France from 
Brazil, in 1672, by a French physician named Le Gras, but 
its value as a remedy for the cure of dysentery did not 
begin to be appreciated until after Helvetius, a semi-quack, 
had sold to Louis the Fourteenth, for one thousand 
louis-d'or (about $4000), the formula for the preparation 
which he (Helvetius) had been using with great success 
during the recent epidemic of that disease, and which 
moreover had effected a remarkably rapid cure in the case 
of the King's own son — the Dauphin. After the purchase 
had been made by Louis the Fourteenth, in the interest of 
the French people in general, it was ascertained that the 
only active reagent among the ingredients of the formula 
was ipecac, a drug with which the Paris physicians had 
long been more or less familiar. Ipecac, it will also doubt- 
less be remembered, constitutes the important element in 
what is known as the East Indian treatment of dysentery. 

Probably the earliest modern treatise on matters con- 
nected with pharmacy is that which bears the title 
*^Onomasticon Latino-Germanico-Polonicum rerum ad 
artem pharmaceuticam pertinentium.^^ It was published 
about the year 1600, and its author was Paul Guldinus. 



410 GROWTH OF MEDICINE 

One of tlie most important iatrochemical authorities of 
the seventeenth century was Johann Eudolf Glauber (1604- 
1668), to whom we are indebted for the invention or 
improvement of a large number of medico-chemical 
products. The well-known *' Glauber's salt" may be 
named as one of these products, and chloride of iron as 
another. 



CHAPTER XXXII 

SOME OF' THE LEADERS IN MEDICINE IN ITALY, 
FRANCE AND ENGLAND DURING THE SIX- 
TEENTH AND SEVENTEENTH CENTURIES 

Eminent French Physicians. — Among the physicians of 
France who attained a widespread and well-grounded 
celebrity throughout Europe during the sixteenth century, 
Pierre Brissot deserves to be given the first place. He was 
born in 1478 at Fontenay-le-Comte, not far from Rochelle, 
and was a professor of medicine at Paris. He attained 
considerable distinction, during the sixteenth century, by 
his advocacy of the superiority of the Hippocratic method 
of bloodletting over that introduced — or, rather, perpet- 
uated — by the practitioners of that day in Central Europe. 
The rule which was laid down by Hippocrates was to the 
effect that, in venesection, the blood should be drawn from 
the vein lying nearest to the part inflamed. The Greek 
physicians of a later period forgot all about this rule and 
adopted in its place one that was based on the doctrine 
that venesection practiced in the vicinity of a focus of 
inflammation favors a determination of blood to that part 
and therefore does only harm; and they accordingly — 
especially in cases of pleuritis — abstracted blood from the 
arm on the side opposite to that on which the disease was 
located, or from one of the veins of the foot. This new rule 
was subsequently adopted by the Arabian physicians, and 
it remained in full force up to the end of the sixteenth 
century. A wide experience in the treatment of the epi- 
demic pleuritis which raged in Paris in 1514 confirmed 
Brissot in the belief that the Hippocratic method is the one 
to be preferred; but, despite his pleadings, the Parisian 



412 GROWTH OF MEDICINE 

physicians refused to adopt the method which he advocated 
and used their influence in securing from the French 
Parliament an order forbidding him to continue employing 
it in Paris. Discouraged by the treatment which he expe- 
rienced in that city, Brissot removed to Lisbon in Portugal, 
and soon had occasion (in the epidemic which raged at 
Evora in 1516) further to satisfy himself that the Hip- 
pocratic rule is the correct one. But here too he encoun- 
tered bitter opposition on the part of the Portuguese 
physicians; his most active opponent being Dionysius, the 
Physician-in-Ordinary to the King. Brissot then wrote an 
elaborate defense of the method which he advocated, and 
this treatise was submitted to the judgment of the Medical 
Faculty of the University of Salamanca. When the deci- 
sion of this learned body was given in Brissot 's favor, his 
opponents, dissatisfied with the result, made still another 
effort to gain their point, viz., by appealing to the Emperor 
Charles the Fifth. They assured his Majesty that the 
Brissot Heresy, as they termed it, was fully as dangerous 
to the cause of humanity as that championed by Luther. 
But here again they failed. This final victory, however, 
brought no satisfaction to Brissot, who died of dysentery 
in 1522, just before the decision was rendered. Haeser 
speaks of this unusually bitter dispute as one of the last 
of the violent battles which occurred between the adherents 
of the Arabian physicians and the supporters of the 
teachings of Hippocrates, and which terminated in '*a most 
brilliant victory of experience over Arabian dogmatism." 
During the first half of the sixteenth century there 
developed a belief, among the more ignorant physicians, 
that, in many cases of illness, important information may 
be derived from a simple naked-eye inspection of the 
patent's urine as exposed to view in a flask-shaped glass 
vessel. In the Hippocratic writings no adequate grounds 
for such a belief are discoverable, but in one of Galen's 
treatises there have been found statements which appear ( ?) 
to give some sanction to this new idea. However this may 
be, it is an established fact that uroscopy was taken up at 
the time named with great zeal by all the quacks in the 







FIG. 16. "THE LOVESICK MAIDEN." 
(After the painting by Jan Steen, 1626-1679.) 

One of this famous Dutch artist's objects, in painting the scene here 
represented, was to satirize the practice, which was very prevalent among 
certain physicians of that period, of pretending to diagnose all sorts of 
maladies from the mere naked-eye inspection of his patient's urine. 

(Courtesy of Dr. Eugen Hollander, author of Die Medizin in der klassi- 
schen Malerei, Stuttgart, 1903.) 



SOME LEADERS IN MEDICINE 413 

land and by large numbers of practitioners of medicine 
who saw in this procedure an easy and safe method of 
bettering their fortunes. The public at large were greatly 
impressed with this new and wonderful manner of detecting 
disease, and for a long period — ^indeed, for more than half 
^ a century — this piece of clap-trap charlatanry continued 
1 to thrive, and to reflect only discredit upon the medical 
profession. There came a time, however, when people 
generally began to suspect that uroscopy was not all that 
the charlatans claimed it to be, and these suspicions were 
voiced in the popular saying, * ' The pulse is good, the urine 
is normal, and yet the patient dies." The writers who were 
the most active in showing up the hollowness of the claims 
of the uroscopists were Scribonius of Marburg, Germany, 
Peter Foreest (1522-1597) of Alkmaar, Holland, and 
Leonardo Botallo of Asti, in Piedmont (born in 1530). The 
latter authority, it may be recalled, owes his chief distinc- 
tion to the fact that he rediscovered what has been 
erroneously named in his honor the ^^ foramen BotallV^ — 
i.e., the ductus arteriosus in the foetus. He also attained 
some distinction in another direction. He revived the 
violent disputes about venesection by recommending a 
resort to this therapeutic procedure in nearly all illnesses. 
He went so far as to advocate four or five bloodlettings in 
the course of an acute attack, in each one of which opera- 
tions from three to four pounds of blood should, as he 
believed, be abstracted. Indeed, he claimed that in an 
extreme case it might be perfectly proper to abstract as 
much as seventeen pounds (l). Inasmuch as Botallo 's 
practice was largely confined to the strong soldiers of 
Northern Italy it is easier to understand how such extrava- 
gant bloodletting did not more often prove fatal than it 
did. When, soon afterward, the Paris Faculty condemned 
the practice in the strongest possible terms, Botallo 's 
followers characterized sarcastically the French physicians 
as ''pigmy bloodletters" {petits saigneurs). 

But the efforts of Scribonius, Botallo and others to put 
an end to the uroscopy scandal were — I fully believe — 
not the only or perhaps even the most potent factors in 



414 GROWTH OF MEDICINE 

bringing about the suppression of the evil. As many of 
our readers will remember, the art collections of European 
capitals contain admirably painted specimens of Dutch and 
Flemish genre pictures representing every phase of this 
uroscopic fraud, and these striking masterpieces, revealing, 
as they undoubtedly did to the community at large, the 
ridiculous character of the claims made by the charlatans, 
could scarcely have failed to give a deadly blow to the 
fraud. (See Fig. 17.) 

In the early part of the sixteenth century Jean Fernel 
of Amiens (1497-1558) was one of the leading medical 
authorities of France. After receiving his degree of 
Doctor of Medicine at Paris, in 1530, he settled in that city 
and soon acquired considerable reputation, not only as a 
practitioner but also as a lecturer. In 1545 he was called 
upon to take charge, professionally, of Diane de Poitiers, 
the mistress of Henry, the son of Francis the First, King 
of France. About the same time he was asked to serve as 
First Physician to the Dauphin, but he was not disposed 
to accept the latter position, as he disliked the duties of 
the office and also because he feared that they would inter- 
fere with his favorite studies. He pleaded poor health, 
and his excuse was accepted as valid. That Fernel was 
held in very high esteem by the royal family is evident 
from the events which succeeded this refusal. In the first 
place, it was insisted that he should accept the stipend 
(600 livres) attached to the office, as a mark of the royal 
favor; and then, in 1547, when Henry was crowned king 
(Henry the Second), Fernel was urged to become his First 
Physician; but again he declined the honor, this time on 
the ground that Louis de Bourges, who had held the position 
with great credit under Francis the First (Henry's father), 
was entitled to be retained in office. The King yielded to 
Fernel 's generous intervention in behalf of de Bourges. 
But in 1556, when the latter died, Fernel felt obliged to 
accept the position which had then become vacant; and 
from that time forward, until the time of his death on 
April 26, 1558, he accompanied the King on all his military 
expeditions. As he did not possess a robust constitution, 



SOME LEADERS IN MEDICINE 415 

his health suffered not a little from the frequent exposures 
to hardships of all sorts to which he was subjected; and, 
in addition, during this long period he saw very little of 
his wife to whom he was devotedly attached. 

Fernel is universally admittedHby French physicians to 
have been one of the most cultivated teachers and prac- 
titioners of medicine of his day. He was a very clear writer, 
and would doubtless have made a number of valuable 
additions to the science if he had not been carried off by 
illness at a comparatively early age. 

Of his published writings the following are reckoned the 
most important: ^^Universa medicina/^ Paris, 1567; ^^De 
abditis rerum causis,^^ Paris, 1548, and ^^ Therapeutic es 
universalis seu medendi rationis libri VII. ,^^ Paris, 1554. 
(Many editions of each of these works were published.) 

In his discussion of various questions relating to physi- 
ology Fernel maintains that the component elements of the 
body are vivified by means of heat, and he elaborates this 
idea very much in the same manner as Hippocrates does 
that of the ' ' callidum innatum. ' ' The spiritual life, he says, 
is presided over by the soul {^'anima^^). When he comes, 
however, to consider the individual powers of the soul, 
Fernel treats the subject exactly as does Galen, He gives 
expression to one rather bright idea: ''The specific 
functions of each of the different organs may be inferred 
in large measure from the character of the structural 
elements of which they are composed." 

In his scheme of pathology Fernel divides diseases into 
simple {^'similares*') — diseases of the tissues; compound 
{^^organicV) — diseases involving entire organs; and 
complicated {^' communes^') — diseases in which the normal 
relations between the different parts are broken up. 

In the chapter which Fernel devotes to the subject of 
therapeutics, there is a section relating to venesection 
which, according to Haeser, is well worth reading, as it 
reveals the power of the writer to grasp the leading points 
and to reason correctly from them. 

Two English Physicians Who Became Famous During 
the Sixteenth Century. — In the early part of the sixteenth 



416 GROWTH OF MEDICINE 

century the medical profession of Great Britain was in a 
most unsatisfactory state. Humbuggery, ignorance and 
superstition were at that period of time the most prominent 
characteristics of the majority of physicians upon whom 
the people at large had to depend for the relief or cure of 
their bodily ailments, and there were very few and very 
untrustworthy measures in force for the production of a 
better class of practitioners. Just at this juncture there 
appeared on the scene a man who was eminently well 
equipped to rescue England from this lamentable state of 
affairs and to put her on the high road to the acquisition of 
an honorable body of medical men and of a corps of 
apothecaries who could be trusted to dispense pure drugs 
properly compounded. I refer to Thomas Linacre, who 
was born at Canterbury in 1461 or 1462, was a Fellow of 
All Souls College, Oxford, and a graduate of the University 
of Padua, and whose biography is sketched by John Freind 
(1675-1728) in such an admirably clear, concise and appre- 
ciative manner that I cannot do better — in view of the great 
importance of this event in the history of medicine in 
England — than to reproduce it here in considerable fulness 
of detail. 

Thomas Linacre was a man of a bright genius and a clear under- 
standing, as well as unusual knowledge in different parts of learn- 
ing: and, being very desirous to make further improve- 
ments by travelling, he thought he could no where succeed in his 
designs so well as by going to Italy, which began then to be famous 
for reviving the ancient Greek and Roman learning. There he 
was treated with extraordinary kindness by Lorenzo de Medicis, 
one of the politest men in his age and a great patron of letters; 
who favoured him so far in his studies as to give him the privilege 
of having the same preceptors with his own sons. Linacre knew 
how to make all his advantages of so lucky an opportunity; and 
accordingly, by the instructions of Demetrius Chalcondylas, a 
native of Greece, he acquired a perfect knowledge of the Greek 
tongue; and so far improved under his Latin master Politian, as 
to arrive to a greater correctness of style than even Politian 
himself 

Having laid in such an uncommon stock of learning, he applied 
himself to the study of natural philosophy and physick; particu- 



SOME LEADERS IN MEDICINE 417 

larly he made it his business, and was the first Englishman who 
ever did so, to be well acquainted with the original works of 
Aristotle and Galen. He translated ~and published several tracts 
of the latter 

In his own Faculty he distinguished himself so much that, soon 
after his return, he was pitched upon by that wise king, Henry the 
Seventh, as t|ie fittest person to be placed about Prince Arthur, 
and to take care both of his health and his education. He was 
afterward made successively Physician to that king, to his suc- 
cessor Henry the Eighth, and to the Princess Mary And 

indeed, as he was perfectly skilled himself in his own art, so he 
always shewed a remarkable kindness for all those who bent their 
studies that way; and wherever he found, in young students, any 
ingenuity, learning, modesty, good manners, and a desire to excel, 
he assisted them with his advice, his interest, and his purse. And 
to give a still stronger proof, how much he had the good of his 
own Profession and that of the Publick at heart, he founded two 
Lectures of Physick in Oxford, and one at Cambridge 

But he had still further views for the advantage of our Profes- 
sion: he saw in how low a condition the practice of Physick then 
was, that it was mostly engrossed by illiterate monks and empiricks, 
who in an infamous manner imposed on the Publick ; the Bishop of 
London or the Dean of St. Paul's for the time being, having the 
chief power in approving and admitting the practitioners in 
London, and the rest of the bishops in their several dioceses. And 
he found that there was no way left of redressing this grievance, 
but by giving encouragement to men of reputation and learning, 
and placing this power of licensing in more proper hands. Upon 
these motives he projected the foundations of our College [of 
Physicians] ; and using his interest at Court, particularly with 
that great patriot and munificent promoter of all learning, Cardinal 
Woolsey, he procured Letters Patent from the King, which were 
confirmed by Parliament, to establish a corporate Society of 
Physicians in this city, by virtue of which authority the College, 
as a corporation, now enjoys the sole privilege of admitting all 
persons whatever to the practice of physick, as well as that of 
supervising all prescriptions. And it is expressly declared that 
no one shall be admitted to exercise physick in any of the dioceses 
in England, out of London, till such time that he be examined by 
the President and three of the Elects, and have letters testimonial 
from them, unless he be a graduate in either University, who, as 
such, by his very Degree, has a right to practice all over England, 



418 GROWTH OF MEDICINE 

except within seven miles of London, without being obliged to 
take any license from the Bishop 

By other Acts another weighty affair is committed to the care 
of the College, [viz.,] the visiting of shops and the inspection of 
medicines; a thing surely of as much consequence at least to the 
patient as to the prescriber 

Linacre was the first president of his new-erected college, and 

held that office for the seven years he lived after And 

perhaps no Founder ever had the good fortune to have his designs 
succeed more to his wish ; this society has constantly produced one 
sett of men after another, who have done both credit and service 
to their country by their practice and their writings. 

If further evidence be needed to show what was the type 
of mind possessed by this remarkable English physician, 
I may be permitted to quote here a single brief statement 
made by his friend Erasmus, the famous Dutch scholar 
and theologian, in a letter addressed to John Fisher, 
Chancellor of Cambridge University: ''Linacre is as deep 
and acute a thinker as I have ever met with. ' ' 

In England, during the seventeenth century, there ap- 
peared on the scene only one practicing physician of such 
conspicuous ability and of so marked personal traits of 
character as to place his name, after the lapse of a few 
years from the time of his death, and by the almost 
unanimous assent of his associates, high up on the roll of 
honor. I refer to the famous physician Sydenham. 

Thomas Sydenham was born at Wynford Eagle, Dorset- 
shire, England, in 1624. At the age of eighteen he entered 
Magdalen College, Oxford, and remained there until 1644, 
when he enlisted in the Parliamentary Army. After a 
brief military service, he resumed his studies at the univer- 
sity and received his Bachelor's degree in 1648. It was 
only at a much later date (1676), however, that he was 
given (after he had pursued the prescribed course of 
studies) the degree of Doctor of Medicine, — and then not 
by Oxford, but by Cambridge. After leaving the university 
he first spent a few months at the Medical School of 
Montpellier, France, and then settled (1666) in London as 
a practicing physician, the necessary license having been 



t/?^- 




FIG. 17. THOMAS SYDENHAM. 
(After the portrait in the hall of All Souls' College, Oxford.) 



SOME LEADERS IN MEDICINE 419 

granted him by the College of Physicians. His first med- 
ical treatise, which bore the title '^Methodus Curandi 
Febres^^ [Method of Treating Fevers], was published in 
1666. The third edition of this work was issued ten years 
later, but with the title changed to ^^Observationes Medicae 
etc." Between 1666 and 1683 he published several other 
treatises, th^ more important of which deal with epidemic 
diseases — syphilis, small-pox, hysteria and gout. 

During the later period of Sydenham's career he attained 
great celebrity as a physician ; but this celebrity would have 
been short-lived if it had rested on nothing more sub- 
stantial than mere cleverness and professional success. 
As a matter of fact he had brought about, by his teaching 
and also by his example, a most important revolution in 
medicine, and it was the appreciation of this fact which led 
the physicians of England to bestow upon him, after his 
death, the appellation of ''The English Hippocrates," and 
which ultimately gave him so highly honorable a position 
in the history of medicine in general. A brief review of 
the state of medicine in England during the seventeenth 
century will enable the reader to understand the full 
importance of the change which Sydenham was instrumental 
in bringing about. 

The physicians of that period were split up into three 
sects : the followers of Galen, with whom should be classed 
the Graeco-Arabists ; the iatrochemists ; and the iatro- 
physicists. 

The Galenists were largely intent upon the strictest 
interpretation of the teachings of Hippocrates, Galen and 
some of the Arabian authors. Instead of studying disease 
itself they devoted their time and thoughts largely to the 
interpretation of the words used by these fathers in medi- 
cine — i.e., to philology. Real progress in the science of 
medicine was not possible along this route. Accepting 
without dispute the dogma of the four humoral qualities, 
together with the different temperaments which result 
from the predominance of any one of them, they combated 
these different temperaments or constitutions by pre- 



420 GROWTH OF MEDICINE 

scribing drugs in a very great variety of combinations 
(polypharmacy) . 

The iatrochemists, attaching small importance to simple 
dietetic measures, prescribed without stint all the most 
active substances belonging to the mineral kingdom and all 
the new remedies which the chemists had evolved from their 
furnaces. 

Finally, the iatrophysicists directed their efforts to the 
removal or diminution of all bodily conditions that appeared 
to act as mechanical hindrances to health. 

Sydenham, who possessed a rare degree of common 
sense, cast aside all these hypotheses, disregarded the 
prevailing routine methods of treatment, and refused to 
accept the therapeutic novelties of the day. ''Nature is 
to be my guide," he declared, and from that time forward 
he studied disease at the bedside, and watched carefully, 
and with a mind free from prejudice, the effects of the 
remedies which he employed. Thus, pursuing the methods 
advocated by the great master Hippocrates, he was able 
to place his medical brethren once more on the pathway 
which leads to an increase in knowledge of the healing art. 
Practical medicine, which had previously been falling into 
an almost moribund condition, was by his efforts made 
again a living and growing science. That Sydenham had 
a perfectly clear conception of what was needed at that 
time to renew the vitality of the medical profession of 
England is plainly shown by the following statement which 
he makes in the dedication of one of his writings to Dr. 
Mapletoft:— ^ 

After studying medicine for a few years at the University of 
Oxford, I returned to London and entered upon the practice of 
my profession. As I devoted myself with all possible zeal to the 
work in hand it was not long before I realized thoroughly that the 
best way of increasing one's knowledge of medicine is to begin 
applying, in actual practice, such principles as one may already 
have acquired; and thus I became convinced that the physician 

1 Translated from the French version printed by Daremberg in his Histoire 
de la Medecine, Vol. II, p. 706. The originals of Sydenham's writings are all 
in Latin. 



SOME LEADERS IN MEDICINE 421 

who earnestly studies, with his own, eyes, — and not through the 
medium of books, — the natural phenomena of the different diseases, 
must necessarily excel in the art of discovering what, in any given 
case, are the true indications as to the remedial measures that 
should be employed. This was the method in which I placed my 
entire faith, being fully persuaded that if I took Nature for my 
guide I shoul4 never stray far from the right road, even if from 
time to time I might find myself traversing ground that was wholly 
new to me. 

In the brief account which I have thus far given of the 
part played by Sydenham in advancing the science of 
medicine, I have called attention only to the general 
character of the services which he rendered. It may now 
be interesting to furnish here a few details that will aid 
in completing the picture of this great English physician, — 
details relating to his life and personal character, to his 
views regarding certain diseases and the remedies which 
he was in the habit of employing for their relief or cure, 
and to his later writings. 

Throughout the greater part of his professional career 
Sydenham was a frequent sufferer from gout, some of the 
attacks being of a severe type and occasionally of long 
duration. During the winter of 1676, for example, he was 
seriously ill from renal calculus, haematuria being brought 
on by the slightest movements of his body. All through 
the year 1677 he continued to experience frequent attacks 
of pain, and on one occasion he was unable to leave the 
house for a period of three months. 

Speaking of the epidemic of the Plague in 1665, during 
the progress of which he left London, Sydenham says: 
''When I saw that the danger was in my immediate neigh- 
borhood I listened to the advice of my friends and joined 
the crowd of those who were fleeing to the country. A 
little later, when the epidemic had further increased in 
severity, and before any of my neighbors had returned, I 
yielded to the calls of those who had need of my services, 
and went back to London." It is worthy of remark, says 
Laboulbene, who fully appreciated the heroism which 
prompted this last decision, that we should never have 



422 GROWTH OF MEDICINE 

known of Sydenham's weakness in regard to facing his 
duty, if he himself had not stated the facts. This famous 
epidemic, as is well known, was accompanied by an appalling 
mortality. 

Andrew Browne, a Scotch physician of good standing, 
entertained serious objections to some of the advice given 
by Sydenham in the treatise entitled ^^Schedula monitoria 
de novae febris ingressu,^'^ and, in order to learn more 
precisely what the author's views on the subject really 
were, he decided to run down to London for a day or two. 
Sydenham gave him such a cordial reception and made his 
stay in the metropolis so pleasant that he remained there 
several months — instead of a day or two. ''And when I 
returned to Scotland I felt contented and joyful as if I 
were carrying back with me a valuable treasure. ' ' 

As an instance of his thoughtful kindness, it is related 
that Sydenham had occasion to treat a poor man who lived 
in his neighborhood for an obstinate bilious colic, but his 
employment of narcotics did not effect very much in the 
way of relief. *'I felt moved by pity for this poor man in 
his misery; and accordingly I loaned one of my horses to 
him in order that he might take long excursions on horse- 
back." 

Sydenham had no eagerness for professional honors, 
although he appreciated highly those which came to him 
spontaneously. As already stated at the beginning of this 
sketch, the degree of Doctor of Medicine was not conferred 
upon him by Cambridge as a mere honorary affair, but was 
won by him after he had passed through the regular course 
of training required of all candidates for this degree. His 
case, however, was peculiar in one respect : he waited until 
after he had been in active practice several years before 
he decided to pass through the course of training required. 
He was not a member of the College of Physicians of 
London, and he held no official position at Court. 

The following summary may serve to convey some idea 
of Sydenham's views regarding pathology and treatment. 

2 Pronounced by Haeser to be a compilation, and not one of Sydenham 's 
genuine writings. 



SOME LEADERS IN MEDICINE 423 

He defines an acute disease as **a helpful effort made by 
Nature to drive out of the body or system, in every way 
possible, the morbific material. ' ' As regards the latter he 
makes the following remarks : — 

Certain diseases are caused by particles which are disseminated 
throughout the atmosphere, which possess qualities that are 
antagonistic ^to the humors of the body, and which — when once 
they gain an entrance into the system — become mingled with the 
blood and thus are distributed throughout the entire organism. 
Certain other diseases owe their origin to fermentations or putre- 
factions of the humors, which fermentations vary in their nature — 
in some cases the humors being excessive in quantity, while in 
others they are bad in quality; and in either event the body finds 
itself incapable of first assimilating them and then excreting them — 
a state of affairs which cannot continue beyond a certain length 
of time without producing further harmful effects. 

According to Sydenham the fever, in the acute diseases, 
assists Nature by separating from the general (total) mass 
of the blood those particles which have undergone putre- 
faction or have been rendered unassimilable. Then they 
are driven out of the body by the route of the sweat-glands, 
by diarrhoea, by eruptions upon the skin, etc. On the other 
hand, in chronic diseases the morbific material is not of 
such a nature as to produce fever, which is a mechanism 
for securing complete purification. It is therefore deposited 
in one part or another of the body where no force exists 
which is capable of ejecting it; or its final transformation 
is not completed until after the lapse of a long period of 
time. 

In some of Sydenham's writings one is occasionally 
surprised to find teachings which seem to be strongly at 
variance with the advice which he was so fond of giving — 
namely, that physicians should be careful not to set up 
hypotheses which are not based upon observed facts. A 
conspicuous instance of such a disregard of his own rule 
may be found in his setting up of a pathological process to 
which he gives the name of "inflammation of the blood." 
This process, he maintains, is the active cause of quite a 
large number of diseases, especially those of an epidemic 



424 GROWTH OF MEDICINE 

nature — such, for example, as pleurisy, pneumonia, rheu- 
matism, erysipelas, scarlet fever, etc. It is well-nigh 
impossible for us moderns to comprehend how so practical 
and clear-headed a man as Sydenham could have formulated 
such a purely hypothetical pathology, a doctrine so com- 
pletely lacking in anything like a solid foundation of fact. 

Sydenham excelled in the description of the clinical 
manifestations of certain diseases, as, for example, small- 
pox, hysterical affections, the encystment of a renal 
calculus, and the gout — a disease from which, as already 
stated, he was a very frequent sufferer throughout a large 
portion of his life. All his published works are in the Latin 
language, but translations have been made into English, 
French, German, Flemish and Italian. At All Souls College, 
Oxford, where Sydenham spent eight years of his life, it 
was a fixed rule that all its members should habitually 
converse and write in Latin. 

Sydenham's remarks upon liquid laudanum are worth 
recording : — 

Of all the remedies which a kind Providence has bestowed upon 
mankind for the purpose of lightening its miseries there is not one 
which equals opium in its power to moderate the violence of so 

many maladies and even to cure some of them Medicine 

would be a one-arm man if it did not possess this remedy 

Laudanum is the best of all the cordials; indeed, it is the only 
genuine cordial that we possess to-day. [This was written in the 
middle of the seventeenth century.] 

The laudanum employed by Sydenham was made accord- 
ing to the following formula : Spanish wine, 400 grammes ; 
Opium, 62 grammes; Saffron, 31 grammes; Powder of 
Canella and Powder of Clove, of each 4 grammes. 

After much suffering and extreme weakness, Sydenham 
died on December 31, 1689. 

Andrew Browne, the Scotch physician of whom mention 
has already been made on an earlier page, makes the 
following comments on the closing days of Sydenham's 
career: *'It is a difficult matter to believe, and yet it is 
the truth: This great physician, who throughout his life 



SOME LEADERS IN MEDICINE 425 

gave the clearest proof of nobility of soul, generosity and 
clear-sightedness, died with the accusation hanging over 
his head that he was 'an impostor and an assassin of 
humanity.' " Laboulbene adds: ''After years of self- 
sacrifice in behalf of his fellow men Sydenham received as 
his final earthly reward calumny and ignominy, and the 
jealousy of many professional brethren." 



CHAPTER XXXIII 

THE THREE LEADING PHYSICIANS OF GERMANY 
DURING THE LATTER HALF OF THE SEVEN- 
TEENTH CENTURY: FRANZ DE LE BOE SYL- 
VIUS, FRIEDRICH HOFFMANN AND GEORG 
ERNST STAHL 

The seventeenth century, says Berendes, was one of the 
saddest periods in the history of Germany ; but, during the 
greater part of this time, the neighboring countries — 
Holland, France, England and Italy — still continued to 
enjoy many of the blessings of the Renaissance, — such, for 
example, as an uninterrupted activity of artistic efforts, 
of scientific work, and of commerce; — ^but in Germany 
everything seemed to be in a state of confusion. A bloody 
religious war was at this period devastating the land, and 
the best powers of the people were being wasted. Instead 
of increasing cultivation of manners and sentiments, there 
was a steady growth of savagery. The Protestants, 
although they probably were numerically superior, were 
split up into factions. The Catholics, on the other hand, 
were united, and their power steadily increased. In 
1618 the disturbances, which previously had been scattered 
in character, took on the form of what in time came to be 
known as *'The Thirty Years' War," a struggle which 
proved to be most sanguinary, costing Germany a great deal 
in every respect. Finally, the war was brought to an end 
by the signing of the Westphalian Treaty of Peace at 
Liitzen, in 1648. Some idea of the terribly destructive 
nature of this long war may be gathered from the fact that 
the population of Germany, which previously had been 



LEADING PHYSICIANS OF GERMANY 427 

estimated at twenty millions, was found to have been 
reduced to about six millions. Whole towns and villages 
were laid in ashes, and as a consequence those who had 
survived the disaster lost confidence in themselves and 
were not able, at least for several years, to undertake 
anything in art, literature or science ; and this depressing 
atmosphere affected in some degree the people of the 
Netherlands. Toward the end of the century, however, 
there came a marked awakening among the younger 
generation of physicians, and in the course of twenty or 
thirty years four men, only three of whom, however, were 
of German birth, succeeded in attaining a decided leader- 
ship in this department of science. The names of the 
Germans are Franz de le Boe (commonly spoken of as 
Sylvius), Friedrich Hoffmann and Georg Ernst Stahl. I 
shall now attempt to furnish, as nearly as possible in 
proper chronological order, very brief sketches of the lives 
of these distinguished physicians, together with an account 
of the contributions which they made to the science of 
medicine. 

Franz de le Boe {Sylvius). — Franz de le Boe (Sylvius) 
was born at Hanau, Prussia, in 1614, of parents who 
belonged to the nobility and were wealthy, and who con- 
sequently were able to give their son every opportunity for 
acquiring an excellent education. Thus Franz first received 
a thorough training in philosophy and the classics and 
afterward visited in turn all the leading universities of 
Holland, France and Germany before he finally took his 
degree of Doctor of Medicine at Basel, Switzerland, in, 
1637. From this time forward, for a period of twenty- 
three years, he devoted himself to the practice of his 
profession, first in his native city and then in Leyden and 
Amsterdam. In 1660 he accepted an invitation to occupy 
the Chair of Medicine in the University of Leyden, and this 
position he held during the remainder of his life. He died 
in 1672. 

As a teacher Sylvius was very popular, Boerhaave alone, 
at a later period, finding greater favor among the crowds 
of medical students and physicians who frequented this 



428 GROWTH OF MEDICINE 

university. Haeser and Haller both attribute some portion 
of this popularity to the fact that Sylvius combined genuine 
eloquence with a wonderful charm of manner and a pro- 
found knowledge of chemistry, pharmacy and pathological 
anatomy. In the practice of medicine he followed Van 
Helmont very closely, but he was not willing to accept his 
teachings about an ^'archaeus insitus^^ and an ^^archaeus 
influus.'* The system which he advocated was of a very 
simple character, and this fact undoubtedly contributed 
much to his popularity among the students. His thera- 
peutic methods were also of a thoroughly practical nature. 

Of the works which Sylvius published the following 
deserve to receive special mention: ^'Disputationes med- 
icae," a book in which are set forth his views regarding the 
fundamental principles of the science of medicine — ^physi- 
ology in particular; *'Z)e methodo medendi,^^ a treatise on 
therapeutics; and ^^Praxeos medicae idea nova/^ a new 
idea concerning the practice of medicine. 

Sylvius was one of the earliest defenders of Harvey's 
great discovery, and he was also one of the first to call 
attention to the part played by chemistry in elucidating 
some of the problems in physiology and pathology. At the 
same time he was always ready to acknowledge the impor- i 
tance of the part played by mechanics in respiration, in the 
circulation of the blood, in the movements of the intestines, 
etc., in which respects he was in entire agreement with the 
iatrophysicists or iatromathematicians.^ 

Finally, there is one more respect in which Sylvius is 
entitled to great credit: he paid most careful attention to 
the work of giving clinical instruction. Recognizing, as I 
do, the importance of this branch of medicine, I shall not 
hesitate to devote here a page or two to a brief review of 
the manner in which it came to hold the honorable position 
which it occupies to-day in all the best schemes for medical 
education. 

During the sixteenth century, as Puschmann assures us, 
an attempt was made at Padua, Italy, to render clinical 

1 Physicians who maintain that all physiological and pathological phenomena 
may be explained by the laws of physics. 



LEADING PHYSICIANS OF GERMANY 429 

instruction an essential part of the physician's education, 
but the difficulties which were encountered proved so much 
greater than was anticipated that it was soon found 
necessary to abandon the plan; and then for many years 
no further effort was made, either at Padua or at any of 
the other Italian medical schools, to introduce clinical 
teaching. After the lapse of nearly a century, Johannes 
Heurnius (1543-1601), Professor of Medicine at the Uni- 
versity of Leyden, made an effort to introduce the plan of 
teaching medicine at the bedside; and a few years later 
(1630) two other professors of the same university — viz., 
Otho Heurnius, son of Johannes, and E. Schrevelius — 
formally introduced clinical instruction at the city hospital. 
The plan which they adopted was the following: The 
students in turn were permitted first to question the patient 
about his ailment and then afterward to make whatever 
physical examination appeared to be necessary; next, each 
one of them stated briefly what he believed to be the nature 
of the malady, and also gave his views as to the prognosis, 
symptoms and treatment; after which the professor com- 
mented on these different reports, pointing out both the 
correct and the incorrect features in each case. After a 
short trial of the plan it became clear that it would have 
to be abandoned, for the students did not like to have 
attention called in such a public manner to their mistakes. 
Then, a few years later, Sylvius, who at that time was the 
Professor of Medicine, introduced a system of clinical 
teaching which is thus briefly described by his colleague, 
Lucas Schacht: — 

When, followed by his pupils, he approached th*e bedside of a 
patient, he assumed the air of one who is entirely ignorant of 
the nature of that person 's malady, of the accompanying symptoms, 
and of the treatment which was being carried out. Then he began 
to ask first one and then another of the students a great variety 
of questions respecting the case that was under consideration, — 
questions which at first seemed to have been propounded in a 
haphazard fashion, but which in reality were so cleverly formu- 
lated as to elicit from the class all the information needed for the 
making of a correct diagnosis, while leaving on the minds of the 



430 GROWTH OF MEDICINE 

students the impression that they, and not the professor, had 
worked out the problem to a successful result. 

This system, if such it may be termed, proved extremely 
successful, and the knowledge of this success spread 
rapidly from one end of Europe to the other, causing 
students and physicians to flock to Leyden from Eussia, 
Poland, Hungary, Germany, Denmark, Sweden, France, 
Italy and England. So long as this particular university 
continued to possess, as a member of its faculty, a pro- 
fessor of medicine who was clever enough to carry on 
clinical instruction with the same profound knowledge of 
human nature as had been displayed by Sylvius, just so 
long did this institution remain without a rival in this part 
of the field of medical education. Then Sylvius was 
followed, in the work of clinical teaching, by Boerhaave, 
a man admirably fitted, both by nature and by the training 
which he had received, to keep the University of Leyden 
in the first rank of medical schools as regards this most 
useful form of discipline. After 1738, the year in which 
Boerhaave died, other universities besides that of Leyden 
began to provide fairly satisfactory facilities for clinical 
study, and among the number of such institutions those of 
Utrecht, Eome, Edinburgh, Paris and Halle deserve to be 
mentioned. The lack of funds and doubtless also the lack 
of the right sort of teachers were the principal reasons why 
these schools were not able to vie with Leyden in furnishing 
the facilities needed for clinical instruction. That the 
fault — at least in the case of the University of Halle — was 
not to be attributed to a failure on the part of the Medical 
Faculty to appreciate the value of such instruction is 
clearly shown b^ the saying attributed to Friedrich Hoff- 
mann, who at that period was the Professor of Medicine : — 

By a mere attendance upon medical lectures no man will ever 
succeed in becoming a properly equipped practitioner of that art ; 
it is indispensable, in addition, jthat he should receive clinical 
instruction. 

The fairly permanent establishment of this fundamental 
branch of medical teaching was not effected until about the 



LEADING PHYSICIANS OF GERMANY 431 

middle of the eighteenth century, when Van Swieten, one 
of Boerhaave's most distinguished pupils, was given full 
authority by the Empress Maria Theresa to furnish, at 
the University of Vienna, all the facilities required for 
successfully carrying on such instruction. From that time 
onward, to a quite recent date, Vienna has been the Mecca 
of all the younger physicians who aspired to become fully 
equipped in the practical branches of the science of 
medicine. 

Georg Ernst Stahl. — Georg Ernst Stahl was born at 
Anspach, Germany, in 1660. Little is known about his 
early life beyond the fact that he pursued his studies at the 
University of Jena, received the degree of Doctor of 
Medicine from that institution in 1684, and shortly after- 
ward began giving private courses in medicine which 
proved to be very popular and soon brought him into 
public notice. In 1687 he was given the position of Court 
Physician at Weimar. In 1694, upon the recommendation 
of Friedrich Hoffmann, who was at that time the incumbent 
of the regular Chair, he was appointed Associate Professor 
of Medicine in the recently founded University of Halle, 
Prussian Saxony; the understanding being that he was to 
devote his attention more particularly to the physiological, 
pathological, chemical and botanical aspects of the subject. 
He held this position up to the year 1716, when he was 
appointed one of the attending physicians of Frederick 
William the First, King of Prussia, and thereafter was 
obliged to reside in Berlin, in which city he died in 1734. 

Stahl was a tireless worker, and wrote a large number 
of treatises (two hundred and forty-four in all) on physi- 
ological and pathological topics — all of them in Latin. 
Albert Lemoine, who has written an elaborate monograph 
on one of these treatises (that relating to anim\sm), says 
that, despite the obscure style in which this and most of his 
other treatises are written, one may, upon careful study, 
satisfy himself that Stahl is a very close reasoner and 
possesses a clear mind. His most conspicuous faults, 
Lemoine adds, are these: he is opinionated and vain, and 
objects strongly to any criticisms that his opponents make ; 



432 GROWTH OF MEDICINE 

and yet he is careful to take up these criticisms one by one 
and subject them to a close analysis. His vanity led him to 
maintain that he was the only person then living who was 
capable of lifting medicine out of the rut in which it was at 
that time rigidly held. He manifested a sovereign contempt, 
not only for the men whose opinions differed from his, but 
also for those who complained of the difficulty of com- 
prehending the Latin in which his treatises are written. 
Finally, Lemoine states that Stahl is addicted to mysticism, 
as is shown by the invocations of all sorts with which he 
begins and ends most of his writings. Haeser adds that 
Stahl possessed a gloomy, reticent and overbearing spirit, 
in striking contrast with the charming sweetness of temper 
of his colleague Hoffmann. 

Among Stahl 's numerous contributions to medical liter- 
ature there is only one in which our readers are likely to 
take any particular interest; I refer to the treatise which 
bears the title "Theoria medica vera^^ — the true theory 
upon which the science of medicine is based. It is in this 
work more particularly that Stahl expounds the doctrine 
of animism. As I have tried in vain to obtain a really 
satisfactory conception of this doctrine, which occupied so 
great a place in the thoughts of the physicians of the period 
between 1650 and 1750, 1 have decided to rest satisfied with 
merely reproducing here the interpretation which William 
Cullen of Edinburgh, one of Stahl 's contemporaries and 
also one of the greatest English physicians of that period, 
gives in his celebrated *' First Lines of the Practice of 
Physic": — 

What is frequently spoken of as the power of nature — the ''vis 
conservatrix et medicatrix naturae'' — resides entirely in the 
rational soul. Stahl supposes that upon many occasions the soul 
acts independently of the body, and that, without any physical 
necessity arising from that state, the soul, purely in consequence 
of its intelligence, perceiving the tendency of noxious powers 
threatening, or of disorders any ways arising in the system, imme- 
diately excites such motions in the body as are suited to obviate 
the hurtful or pernicious consequences which might otherwise take 
place. 



LEADING PHYSICIANS OF GERMANY 433 

Barthelemy St. Hilaire of Paris (1805-1895) in one of his 
writings says: **I am convinced that the central idea in 
Stahl's physiology was suggested to him by the reading 
of Aristotle's ^De anima,^ in which this great philosopher 
states that the soul nourishes the body, and also that 
nutrition is one of the four ways in which the soul manifests 
itself." 

Speaking of the effect of Stahl's doctrines upon the 
actual practice of medicine as a whole, Cullen says that it 
was of a controlling character, leading physicians to 
propose the **art of curing by expectation"; the natural 
result of which was that they advocated for the most part 
the employment of only very inert and frivolous remedies. 
On the other hand, they zealously opposed the use of 
some of the most efficacious drugs, such as opium and the 
Peruvian bark, and resorted to bleeding and to the 
administration of emetics only in exceptional cases. Cullen 
adds that: — 

The Stahlian system has often had a very baneful influence on 
the practice of physic, as either leading physicians into, or con- 
tinuing them in, a weak and feeble practice, and at the same time 

superseding or discouraging all the attempts of art The 

opposition to chemical medicines in the sixteenth and seventeenth 
centuries, and the noted condemnation of antimony by the Medical 
Faculty of Paris, are to be attributed chiefly to those prejudices 
which the physicians of France did not entirely get the better of 
for near a hundred years after. We may take notice of the reserve 
it produced in Boerhaave with respect to the use of the Peruvian 
bark. 

Stahl, after taking up his residence in Berlin, devoted 
himself energetically to the increase and spread of the 
knowledge of chemistry. The thing which brought him the 
greatest celebrity, both in his own lifetime and also during 
the years following his death, was his propounding of the 
'* phlogiston" theory. This theory was to the effect that 
all combustible materials or substances contain (as he 
assumed) an element to which he gave the name of 
phlogiston. He was not able, however, to demonstrate the 
actual existence of this element; he simply assumed that 



434 GROWTH OF MEDICINE 

it existed. At the same time the fact should here be stated 
that the terms ''oxidation" and ''reduction," which came 
into use during the following century, developed out of this 
theory of phlogiston. 

Friedrich Hoffmann. — Friedrich Hoffmann was born at 
Halle, Prussian Saxony, February 19, 1660, and received 
his medical education in his native city, largely under the 
direction of his father, who was himself a physician. In 
1678 he attended lectures at the University of Jena, and 
in the following year visited Erfurt in order to benefit from 
the instruction of Caspar Cramer, who was at that time 
a distinguished authority in chemistry. At the end of two 
years he returned to Jena, took his degree of Doctor of 
Medicine, and acquired the right to deliver public lectures. 
Then, during the following three years, he visited Holland 
and England, and, upon his return in 1685, settled at 
Minden, Westphalia, as a general practitioner of medicine. 
In 1686 he was appointed District Physician of the Princi- 
pality of Minden and also Court Physician of the Prince 
Elector; and two years later he accepted the position of 
District Physician at Halberstadt. After the inauguration 
of the new university at Halle, July 12, 1694, Hoffmann 
appears as one of the earliest professors chosen to serve the 
institution. In 1701, when Frederick the Third, Electoral 
Prince of Prussia, assumed the crown under the title of 
Frederick the First, King of Prussia, he extended to Hoff- 
mann an invitation to come to Berlin and accept the 
position of Private Physician to His Majesty. Hoffmann 
was not at first willing to accept the invitation, but in 1708, 
when the King, who had then become seriously ill, renewed 
his request, Hoffmann accepted, on condition that he might 
retain his professorship. In 1712 he returned to Halle and 
remained there until he died in 1742. 

Before Hoffmann's time very little was known concerning 
the nature of carbonous (or carbonic) oxide and concerning 
the fatal effects which may be produced by inhalation of 
this gas. It was a common belief, for example, that the gas 
was given off by freshly plastered walls ; and — as an even 
worse error — the theological authorities showed an incli- 



LEADING PHYSICIANS OF GERMANY 435 

nation, in many of the fatal instances which probably were 
due to inhalation of carbonous oxide, but in which no 
recognizable cause of death had been discovered, to explain 
the event as due to the malign interference of the Devil. 
In our time it is well understood in the community that the 
fumes of carbonous oxide constitute the most dangerous 
gas that one is liable to encounter, but in Hoffmann's day 
the people appear to have been less well informed concern- 
ing this danger than they were in ancient times. In the 
treatise on this subject which Hoffmann published in 1716,^ 
several of the earliest known instances of such poisoning 
are narrated, the first one being that mentioned very briefly 
by Aristotle (384-322 B. C). Then follow two very short 
references to this subject in the *'Z)e rerum natura^^ of the 
Roman poet Titus Lucretius Cams (95-52 B. C). They 
read as follows: (1) **The fumes of burning charcoal 
easily aifect the brain if thou hast not first taken a drink 
of water." (Book VL, verse 803.) (2) ''If the fumes of 
the night lamp,^ after it has been extinguished, are inhaled 
rather deeply the effect experienced will be the same as if 
one had been struck down by a blow on the head." (Book 
VI., verse 792.) The idea that the previous drinking of 
water is competent to prevent the effects of poisoning by 
charcoal fumes is declared by Neuburger, the translator 
of Hoffmann's treatise, to be erroneous. 

The earliest really satisfactory description of an instance 
of non-fatal poisoning by the fumes of burning charcoal is 
credited by Hoffmann to the Roman Emperor, Julian the 
Apostate, who reigned from 361 A. D. to 363 A. D. Before 
he was made Emperor, Julian was intrusted by Constantius 
II., in 355 A. D., with the government of the Province of 
Gaul, and in 357 he won a great battle against the Alamanni 
at Strassburg; after which he took up his residence in the 
little city of Lutetia, the present Paris. It was undoubtedly 

2 ' ' Griindliches Bedenken und physicalische Anmerkungen von dem todt- 
lichen Damff der Holzkohlen," Halle, 1716. 

8 Probably this refers simply to a brazier containing burning charcoal, the 
light emitted by which would doubtless be sufficient to answer the purpose of a 
night lamp. 

/ 



436 GROWTH OF MEDICINE 

soon after this event that he wrote the Greek satire which 
bears the title *'Misopogon," and from which Hoffmann 
quotes the following account of Julian's narrow escape 
from death through the poisonous effects of carbonous 
oxide : — 

The little city which the Celts call Lutetia is built upon a small 
island in the midst of a river, and access to it from both sides is 
gained by means of wooden bridges. Ordinarily the winter climate 
in this region is mild, owing — as the people of the place claim — 
to the proximity of the Ocean. Good wine is produced there, and 
even fig-trees flourish provided care be taken to wrap them well 
in wheat straw or some similar protective material during the winter 
season. But my visit happened to have been made during an 
exceptionally severe winter, and as a result things which looked 
like slabs of Phrygian marble, closely packed together, were con- 
stantly floating down the river with the current, and, soon becoming 
jammed, they formed a sort of natural bridge. Although most of 
the houses — the one I occupied among the number — were provided 
with fireplaces and chimney-flues, and might therefore readily be 
heated, I was not willing that a fire should be kindled in my 
bedroom. I wa§ very little sensitive to cold, and, in addition, I 
was desirous of becoming more and more hardened to its influence. 

As the severity of the weather, however, showed no signs 

of letting up, I permitted the attendants to bring into the room 
a few glowing coals, just enough to render the air of the chamber 
less chilly. But, notwithstanding the very small degree of heat 
which these few burning coals supplied, it proved to be sufficient 
to draw out from the damp walls exhalations that caused my head 
to feel as if it were tightly held in a vice and also produced a 
sensation as if I were choking. I was immediately removed from 
the room, and the physicians who were promptly summoned 
administered an emetic which enabled me to get rid of the food 
which I had eaten a short time before. Soon afterward I had a 
refreshing sleep and was able on the following day to resume my 
work as usual. [Translated from the German version printed in 
Neuburger 's monograph. ] 

As will be seen from the reports which I have just quoted, 
there existed among the Germans, early in the eighteenth 
century, no fixed belief as to the real cause of death in many 
of these unexplained fatal cases; and it was therefore no 



LEADING PHYSICIANS OF GERMANY 437 

small public service which Hoffmann rendered when he, 
in whose judgment about such matters the people at large 
placed the greatest confidence, published such a clear and 
simple explanation of the real cause of these deaths as that 
which is given in this interesting monograph. 

Hoffmann also added not a little to his fame by the 
invention of a remedy which was first known as '* Hoff- 
mann's drops," but which to-day appears in the United 
States Pharmacopoeia under the name of ''Hoffmann's 
anodyne" or ^^spiritus aetheris compositus^^ (sulphuric 
ether, 325; alcohol, 650; ethereal oil, 25). 



CHAPTER XXXIV 

HERMANN BOERHAAVE OF LEYDEN, HOLLAND, 
ONE OF THE MOST DISTINGUISHED PHYSI- 
CIANS OF THE SEVENTEENTH CENTURY 

Hermann Boerhaave, who was born at Voorhont, near 
Ley den, Holland, on December 31, 1668, was the son of a 
poor but highly educated clergyman; and it was owing to 
this circumstance that he received in early youth a most 
careful training in Latin and Greek and in belles-lettres. 
At the age of fourteen he entered the public school of 
Leyden, and made such rapid progess in his studies — 
history, mathematics, the different branches of natural 
philosophy, Hebrew and Chaldean languages, and meta- 
physics — that he was soon able to follow regularly the 
lectures given at the university. He was only fifteen at 
the time when his father died, leaving him absolutely 
penniless; but Van Alphen, the Burgomaster of Leyden, 
befriended him and furnished all the funds needed for a 
continuance of his studies at the university. But young 
Boerhaave, who was not willing to be entirely dependent 
on the aid thus provided, contributed to his own support 
not a little by giving private instruction to young students 
of the wealthy class. In 1690 he received the degree of 
Doctor of Philosophy, the subject of his dissertation being 
a refutal of the doctrines of Epicurus, Hobbes and Spinosa. 
His original intention had been to prepare himself for the 
ministry, but, after continuing his studies in theology for 
a short time, he determined that the better course for him 
would be to choose the career of physician. Accordingly 
he began, at the age of twenty-two, to study the anatomical 
treatises of Vesalius, Fallopius and Bartholinus, and at the 
same time he followed a course of instruction in dissecting. 



HERMANN BO ERE AAV E OF HOLLAND 439 

under the guidance of the anatomist Nuck, and also occa- 
sionally attended the lectures given by Drelincourt, who 
at that time was Professor of the Theory of Medicine. In 
his reading of medical literature he showed a decided 
preference for the writings of Hippocrates and Sydenham ; 
and he devoted a large portion of his time to the study of 
botany and chemistry, two branches of the science of medi- 
cine in which he took a very strong interest all through 
life. In 1693 he received the degree of Doctor of Medicine 
from the University of Harderwyk.^ In 1701 he was 
appointed Associate Professor of the Theory of Medicine 
in the University of Leyden, and it was in this capacity 
that he began building up that great reputation which in a 
very few years brought crowds of students from all parts 
of the world to Leyden. As already stated on a previous 
page, he owed a large part of his fame to the admirable 
manner in which he conducted his clinical teaching. To 
show how widely he was known throughout Europe the 
story is told that a letter which had been sent to him from 
a mandarin living in China and which bore the address, 
*'To the illustrious Boerhaave, Physician in Europe,'* 
reached him in due course. 

Soon after his first appointment at Leyden, he received 
other most flattering offers, such as that of William the 
Third, Hereditary Prince of the Netherlands, to accept the 
position of Court Physician at The Hague, and a call from 
the University of Groningen (1703) to occupy the Chair 
of Medicine. He declined these offers as he preferred to 
remain at Leyden; but, a few years later, in 1709, he 
accepted the full professorship of the Practice of Medicine 
in the institution with which he was already connected. 
From the vantage ground of this more responsible position 
he was able most successfully to teach the students the best 
methods of observing, identifying and treating the different 
diseases ; and as a further result of this promotion in rank 
his private practice grew rapidly, monarchs and princes 

1 A small seaport town located on the Zuider Zee, about thirty miles north- 
east of Amsterdam. The university, which was founded there in 1648, was 
abandoned in 1818. 



440 GROWTH OF MEDICINE 

coining from every country in Europe to consult him about 
their maladies. Boerhaave was also most popular among 
his fellow townsmen. It is related of him, for example, 
that on one occasion, after he had been confined to the 
house for about six months by an illness of a gouty nature, 
the citizens of Leyden manifested their joy at his recovery 
by inaugurating a general illumination of the town during 
the evening of the day on which he made his first appear- 
ance on the street. He had two relapses of the gouty 
affection, one in 1727 and another in 1729, and he finally 
died from disease of the heart on September 23, 1738. The 
monument raised in his honor by the city of Leyden bears 
the inscription: "Salutifero Boerhaavii genio sacrum'* 
(Sacred to the memory of the health-giving genius of 
Boerhaave). 

Some idea of the lucrative character of Boerhaave 's 
private practice may be gained from the fact that he left 
to his only child, a daughter, the sum of about four million 
francs. And yet he was noted for the generous gifts which 
he made during his lifetime to all sorts of scientific and 
benevolent objects. 

Boerhaave, says Dezeimeris, exercised during his career, 
and also for a long time after his death, an immense 
influence upon medical thought. He is justly ranked, he 
adds, among the iatromathematicians, and it is correct to 
say that he was largely instrumental in overthrowing the 
chemical system which de le Boe (Sylvius) had developed. 
His own treatise on this branch of knowledge (''Elementa 
Chemiae"), which was published toward the end of his 
life, soon became the standard work on this subject, and 
it retained its popularity for many years. *'It is to be 
regretted that, possessing as Boerhaave unquestionably 
did, remarkable powers of observation, he should have 
allowed himself, in opposition to the very principles which 
he advocated so strongly, to indulge in the making of 
systems and hypotheses. He commenced by advocating 
with enthusiasm the method of Hippocrates, and ended by 
following the brilliant but not very trustworthy example 
of Galen." (Dezeimeris.) 



HERMANN BOERHAAVE OF HOLLAND 441 

The number of treatises which Boerhaave published is 
quite large, the 'most important among them being the 
following: ^'Oratio de commendando studio Hippocratico,^^ 
1701; ^^Institutiones medicae in usus annuae exercitationis 
domesticos,^^ 1708; ^'Aphorismi de cognoscendis et curandis 
morhis in usum doctrinae medicae,'^ 1709 (English version 
printed in London in 1742) ; and ^'Elementa chemiae,^^ 1732 
(English translation by Peter Shaw, London, 1741). 

Of the ''Aphorisms," one of the most widely known of 
Boerhaave 's published treatises, I shall take the liberty of 
saying a few words. This work is in reality a very concise 
statement of the author's views regarding pathology, 
pathological anatomy and therapeutics, and I believe that 
the following paragraphs, although few in number, will 
suffice to give our readers a fair idea of the general 
character of the book. At the same time I must confess 
that I have not found it an easy matter to understand and 
satisfactorily digest many of the individual aphorisms, the 
text of which has been compressed into such a small space. 
It therefore does seem surprising to learn from one critic 
that, if one wishes to ascertain what Boerhaave 's views are 
with regard to the science of medicine, one should read 
by preference the Commentaries of Van Swieten, who was 
Boerhaave 's favorite pupil and assistant. 

The following four or five aphorisms are typical speci- 
mens belonging to the earlier sections of the book:—* 

(7.) A disease when present in a body, must needs be the bodily 
effect of a particular cause directed to that body. 

(8.) Which effect being entirely removed, health is recovered, 

(9.) It may be removed by correcting the illness itself in par- 
ticular, viz., by the applications of medicines to the particular 
diseased part, or by some remedies which operate equally upon the 
whole : the first we '11 call a particular, the latter a general cure. 

(10.) The way to both is discovered either by observation, or 
by comparing one case with another, or by a true reasoning from 
them both. 

(13.) He who doth, with the greatest exactness imaginable, 
weigh every individual thing that shall happen or hath happened 

2 Quoted from the English translation mentioned above. 



442 GROWTH OF MEDICINE 

to his patient and may be known from the observations of his own 
or of others, and who afterward compareth all these with one 
another, and puts them in an opposite view to such things as happen 
in an healthy state; and lastly, from all this, with the nicest and 
severest bridle upon his reasoning faculty, riseth to the knowledge 
of the very first cause of the disease, and of the remedies fit to 
remove them; he, and only he, deserveth the name of a true, 
physician. 

Then Boerhaave proceeds to make a classification of 
diseases, and among the very first groups which one finds 
in this classified list are the following: ''Distempers of 
a lax and weak fibre " ; ' ' Distempers of the stiff and elastic 
fibre"; ''Distempers of the less and larger vessels"; 
"Distempers of weak and lax entrails"; "Distempers of 
the too strong and stiff entrails"; etc. — from which it is 
apparent that the old doctrine of the strictum and the 
laxum, which was taught by the Methodists in the early 
centuries of our era, has here been adopted by Boerhaave 
in all its essential characters ; and also that the treatment 
which he recommends for some of these classes of maladies 
does not materially differ from that advocated by this 
ancient school of medicine. The following extracts, I 
believe, will suffice to give the reader a fairly clear under- 
standing of what Boerhaave means by the expressions 
"distempers of the solid simple fibre," "distempers of a 
lax and weak fibre, ' ' and ' ' distempers of the stiff and elastic 
fibre," and will at the same time show what methods he 
employed for overcoming these distempers. At the time 
when Boerhaave made use of the term "fibre" (fibra) in 
the very uncertain sense in which he here employs it, 
Leeuwenhoek and Malpighi were demonstrating, by aid of 
the newly perfected microscope, that the so-called simple 
tissues were in reality quite complex structures; and one's 
first impulse, therefore, is to express surprise that a physi- 
cian of such high standing as our author should have used 
the term. But we moderns must not forget that, in those 
early days, it took decades for knowledge of this nature to 
spread even a very short distance, as from Delft to Leyden, 
and then to exert its legitimate influence upon^ medical 



HERMANN BOERHAAVE OF HOLLAND 443 

thought — that is, to be digested and afterward permanently- 
appropriated. There can be scarcely any doubt that, at the 
time (1709) when Boerhaave wrote these aphorisms, he had 
already heard about the existence and the capabilities of 
the recently perfected microscope, but it is not at all likely 
that he had as yet digested the gains in anatomical knowl- 
edge which had been acquired through the assistance of this 
instrument. The extracts referred to above are the 
following : — 

DISTEMPERS OF THE SOLID SIMPLE FIBRE 

(21) Those parts (which, being separated from the fluid con- 
tained in the vessels, are applied and sticking to each other by the 
strength of the living body, and make the least fibre) are the least, 
the simplest, earthy, and hardly changeable from or by virtue of 
any cause, which are found in our living bodies. 

DISTEMPERS OF A LAX AND WEAK FIBRE 

(24) The weakness of the fibre is that cohesion of the minutest 
parts described (21), which is so loosely linked that it may be 
pulled asunder even by that degree of motion which is requisite 
in healthy bodies, or not much exceeding it, 

(26) The weakness produceth easily a stretching and a breaking 
of the small vessels made up of those weak fibres (24), and conse- 
quently abates of their power over the fluids therein contained; 
from which distensions arise tumors, from the stagnating or 
extravasated liquids putrefactions, and, farther, all such innumer- 
able ills as are the consequences of them both. 

(28) [In distempers of a lax and weak fibre] the cure must be 
obtained, 1. By aliments that abound in such matter as is described 
in section 21, and which [should] be almost so prepared beforehand 
as they are in a strong and healthy body; such are milk, eggs, 
flesh-broths, panadoes^ rightly prepared of well-fermented bread; 
and rough wines. All which must be given in small quantities, but 
often, 2. By increasing and invigorating the motion of the solids 
and fluids by means of frictions with a flesh-brush, or with flannel ; 
by riding on horse-back, and in a coach, or by being carried in a 
boat; and lastly by walking, running and other bodily exercises. 
3, By a gentle pressure or a bandage upon the vessels, and a 
moderate repelling of the liquids therein contained. 4. By medi- 

3 Bread boiled in water to the consistence of pulp. 



444 GROWTH OF MEDICINE 

cines both acid and austere, or such as are spirituous and well 
fermented, but applied with great caution and gentleness. 5. By 
any means that will remove and remedy the too great pulling of 
them. 

[That Boerhaave belonged to the iatrophysical or iatro- 
mechanical school appears very clearly throughout these 
quotations.] 

DISTEMPEES OF THE STIFF AND ELASTIC FIBEE 

(35) [In distempers of this group] the cure is effected, 1. By 
such meat and drink as is thin and watery, without any roughness, 
chiefly by the continued use of milk-whey, of the softest herbs and 
salads, barley-water, thin gruel, and unfermented liquors. 2. By 
avoiding of exercise, and dwelling in a moist, coolish air, and taking 
long sleeps. 3. By the taking or outwardly applying watery, luke- 
warm, tasteless medicines, and such as contain the lightest and 
softest oils. 

In the second half of the volume I find abundant evidence 
of Boerhaave 's ability to treat efiiciently some of the acute 
and chronic maladies; and, after a perusal of the text 
which deals with these affections, I have no difficulty in 
understanding how he came to be looked upon as one of 
the leading medical practitioners of the period during which 
he lived. I should be glad to reproduce here such portions 
of the aphorisms as would corroborate the statement that 
I have just made, but unfortunately the small amount of 
space that I can command does not permit me to do this. 
At every step, as I advance, I am warned against the danger 
of exceeding the limits permitted, and I shall, therefore, 
in the present instance, have to rest satisfied with quoting 
the larger part of a single paragraph in which is given an 
account of the treatment employed in a case of acute 
pleurisy. 

(890) If the same pleurisy be recent before the end of 

the third day, yet violent from the many and strong symptoms, 
and dry, in a strong, exercised, dry body, without the hopes of the 
presence of (887 and 888) [a resolution or a concoction and excre- 
tion of the cause], then let the patient immediately be blooded 



HERMANN BOERHAAVE OF HOLLAND 445 

largely, with a qui^k running stream out of a great vessel, and a 
large orifice, keeping his body quiet and leaning backwards, enforc- 
ing his breathing all the while with coughing or panting, fomenting 
the side at the same time, and gently rubbing it; which bleeding 
ought to be continued till the pain seems to abate pretty consider- 
ably, unless a fainting fit forces you to leave off sooner ; at whose 
approach the vein must immediately be stopped. Bleeding ought 
to be repeated according as these symptoms do return upon whose 
account it was done the first time; and when that skin doth not 
any longer appear upon the surface of the blood, it is time to 
forbear more bleeding. 

From the beginning ought to be used fomentations, bathings, 
warm streams, liniments, plaisters, and the like; which may be of 
use as they loosen, resolve, mitigate, and avert 

As only extracts of considerable length would suffice to 
give our readers a satisfactory idea of the attractive manner 
in which Boerhaave deals with the subject of chemistry, I 
prefer to omit them altogether, and to recommend to those 
who are specially interested in this branch of science, that 
they consult Peter Shaw's excellent English translation of 
the ^^Elementa Chemiae.^' 

Albert von Haller, the celebrated Swiss physiologist and 
historian of medical literature, speaks of Boerhaave as 
*'my beloved preceptor, a man of refined taste and a 
speaker or lecturer so logical and charming that one more 
gifted can hardly be imagined." 



CHAPTER XXXV 

GENERAL REMARKS ON THE DEVELOPMENT OF 
SURGERY IN EUROPE DURING THE FIFTEENTH 
AND SIXTEENTH CENTURIES 

In the early period of the Renaissance surgery was 
apparently the first of the practical branches of medicine 
to spring forward into active life. Anatomy, — that is, 
human anatomy, — the foundation that is absolutely neces- 
sary to the solid growth of surgery, scarcely existed before 
the beginning of the sixteenth century; and it is therefore 
not surprising that the records of the past reveal to us so 
very few instances of men who attained any eminence as 
surgeons. When this fact is taken into consideration I 
cannot help feeling that, in the sketches which I drew, 
on earlier pages, of Theodoric of Cervia, William of 
Saliceto, Lanfranchi of Milan (and later of France), Henri 
de Mondeville and Guy de Chauliac, I gave to these men 
only a small fraction of the credit to which they were justly 
entitled. Indeed, the excellence of the work done by them 
and recorded in the treatises which they published, is so 
great as to arouse the suspicion that they had clandestinely 
acquired more knowledge of human anatomy than they 
dared to admit. The life of a dissector of human bodies, it 
should be remembered, was by no means safe in those days. 

But the lack of a trustworthy knowledge of anatomy was 
not the only hindrance to a healthy development of the art 
of surgery. There were other obstacles which, up to a 
comparatively late period in the sixteenth century, con- 
tinued to block the advance of this art. Of these, the 
principal one was perhaps the custom — not by any means 
considered at that period professionally dishonorable — of 



GENERAL REMARKS ON SURGERY 447 

keeping secret ^he technique of certain operative pro- 
cedures like that of cutting for stone in the bladder or that 
of the radical cure of hernia. Such knowledge was treated 
as private property, and was very carefully handed down 
from father to son, or was sold for a large sum of money 
to certain surgeons who engaged, under oath, not to reveal 
the details to others. Thus we are assured by Haeser that 
two such eminent surgeons as Ambroise Pare and Fabricius 
of Hilden were obliged to pay handsomely for the infor- 
mation which they received from certain specialists con- 
cerning their particular methods of procedure. It is from 
such scraps of information which come to our knowledge 
casually that we often learn the actual truth concerning 
the advance made at a given period of time by a certain 
department of medical science. Although it is not possible 
to fix the date when the custom to which I have just referred 
was definitely abandoned, it may be stated as a fact that 
after the seventeenth century very few instances of such 
ownership of surgical secrets are discoverable in the 
records. 

Inasmuch as at the very beginning of the Renaissance 
surgery was looked upon, in the southern and central parts 
of Europe, as an occupation of a somewhat menial char- 
acter, the regularly organized medical schools made very 
inadequate provision for the proper education and training 
of those young men who were disposed to adopt a surgical 
career. During the fourteenth and fifteenth centuries 
surgery was still tolerated at Montpellier, but after the 
papal seat had been removed from Avignon to Rome — 
that is, after 1479, — the pupils of that university were 
forbidden to do any surgical work. In 1490, however, a 
course in surgery was provided for the exclusive use of 
barbers. At first the instruction was given in Latin, but, 
as these men did not understand this language, the pro- 
fessor was soon compelled to employ a barbaric Latin 
(half French and half Latin) in making his comments upon 
the text of the lecture. This state of affairs lasted for more 
than a century. In fact, it was not until after Pare, Franco 
and Wuertz had demonstrated by their remarkable careers 

/ 



448 GROWTH OF MEDICINE 

how honorable was this branch of the science of medicine, 
that provision was made at Montpellier (in 1597) for 
regular instruction in surgery. But even then, for a period 
of several years, it was found to be a very difficult matter 
to keep the peace between the two groups of students — the 
medical and the surgical; the governing authorities being 
finally obliged, in order to prevent the encounters which 
frequently took place between the rival bodies, to appoint 
four a.m. as the hour when the instruction in surgery was 
to be given. Those students who were pursuing the course 
.in medicine looked upon the surgical pupils as intruders, 
as men unworthy to associate with them, and they availed 
themselves of every possible opportunity for making their 
connection with the university unpleasant. 

In Paris, during the twelfth and thirteenth centuries the 
surgeons formed themselves into corporations. Minor 
surgery was left entirely in the hands of the barbers (a 
word which is derived from the Latin ^^barbarus,'^ uncul- 
tivated) and barber-surgeons. They were largely itinerant 
practitioners and army surgeons. As they traveled from 
one city to another, the more enterprising ones announced 
their approach by means of a sort of herald who proclaimed 
loudly the cures which his chief was able to accomplish. 
In the course of time the surgeons who lived in Paris 
formed themselves into the so-called '* College of Surgeons." 
At a later date (1255) there was established in that city by 
Jehan Pitard, the surgeon of Louis the Ninth ('^ Saint 
Louis," 1215-1270), a more perfect organization under the 
name of the '* College of Saint Cosmas," which was placed 
under the protection of Saints Cosnias and Damian. The 
members of this Brotherhood were known as *' Surgeons 
of the Long Robe," to distinguish them from the Barber- 
Surgeons or ' ' Surgeons of the Short Robe ' ' ; and they were 
also known as ^^Maitres Chirurgiens Jures.^' Through the 
influence of Pitard this organization received from the King 
a set of governing rules or constitution. 

It may prove interesting to learn who Cosmas and 
Damian were, how they came to be canonized, and for what 
reasons the organizers of the new brotherhood preferred 



GENERAL REMARKS ON SURGERY 449 

them to all others, as guardian saints. Cosmas and Damian 
were the youngest of five brothers who belonged to a family 
of some distinction in Arabia. They chose the career of 
peripatetic physicians, and gave their services free to those 
who might have need of them. They spent some time in 
the Province of Cilicia, Asia Minor, and while in that 
country they met the death of martyrs, somewhere about 
287 A. D,, during the persecutions of the Christians which 
occurred in the reign of Diocletian. In the church pictures 
they are represented as physicians, each one of whom holds 
in his hand either a vessel containing a remedial prepara- 
tion, or a staff around which the emblematic serpent is 
twined, or (less frequently) a surgical instrument of some 
kind. During the time of the Crusades there existed an 
Order of Knights of Saint Cosmas and Saint Damian, who 
devoted themselves specially to the care of sick pilgrims 
and to the freeing of those who were held as prisoners. 

In all the large cities of France there existed, during the 
fourteenth and fifteenth centuries, corporations of surgeons, 
the great majority of whom belonged to the class or grade 
of barbers. These men were not permitted by their rules 
to use the knife, and, as a result, great jealousy existed 
between them and the few who, having passed the required 
examination, were authorized to perform cutting operations 
and to assume the title of ' ' Masters in Surgery. ' ' In 1493, 
as the result of an effort made by the barbers of Paris as 
a body, to gain some knowledge of medical science, they 
obtained from the university permission to purchase a 
corpse which had not yet been removed from the gallows. 
They had, it appears, engaged a doctor of medicine to give 
them instruction in anatomy, and it was upon a dissection 
of this body that the teaching was to be based. In 1494 the 
Faculty made provision for giving the barbers a regular 
course of lectures on surgery